The a-Z Guide to Food As Medicine [2nd ed] 9780429942518, 0429942516

Table of contents :
Content: Cover
Half Title
Title Page
Copyright Page
Contents
Foreword
Preface
Acknowledgments
Author
Chapter A
Açaí Berry (Euterpe oleracea)
Definition
Scientific Findings
Bioactive Dose
Safety
Alfalfa (Medicago sativa)
Definition
Scientific Findings
Bioactive Dose
Safety
Allium Vegetables
Definition
Scientific Findings
Bioactive Dose
Safety
Allspice (Pimenta dioica)
Definition
Scientific Findings
Bioactive Dose
Safety
Almond (Prunus dulcis)
Definition
Scientific Findings
Bioactive Dose
Safety
Anise (Pimpinella anisum)
Definition
Scientific Findings
Bioactive Dose SafetyAnthocyanins
Definition
Scientific Findings
Bioactive Dose
Safety
Antioxidant
Definition
Scientific Findings
Bioactive Dose
Safety
Apple (Malus sylvestris)
Definition
Scientific Findings
Bioactive Dose
Safety
Apricot (Prunus armeniaca)
Definition
Scientific Findings
Bioactive Dose
Safety
Artichoke (Cynara scolymus)
Definition
Scientific Findings
Bioactive Dose
Safety
Arugula (Eruca sativa)
Definition
Scientific Findings
Bioactive Dose
Safety
Asian Pear (Pyrus pyrifolia)
Definition
Scientific Findings
Bioactive Dose
Safety Asparagus (Asparagus officinalis L.)Definition
Scientific Findings
Bioactive Dose
Safety
Astaxanthin
Definition
Scientific Findings
Bioactive Dose
Safety
Avocado (Persea americana)
Definition
Scientific Findings
Bioactive Dose
Safety
References
Chapter B
Banana (Musa paradisiaca)
Definition
Scientific Findings
Bioactive Dose
Safety
Barley (Hordeum vulgare L.)
Definition
Scientific Findings
Bioactive Dose
Safety
Basil, sweet (Ocimum basilicum)
Definition
Scientific Findings
Bioactive Dose
Safety
Beer
Definition
Scientific Findings
Bioactive Dose
Safety Scientific FindingsBioactive Dose
Blueberry (Vaccinium spp.)
Definition
Scientific Findings
Bioactive Dose
Safety
Bok Choy (Brassica campestris)
Definition
Scientific Findings
Bioactive Dose
Safety
Boron
Definition
Scientific Findings
Bioactive Dose
Safety
Boysenberry (Rubus ursinus)
Definition
Scientific Findings
Bioactive Dose
Safety
Brassica Vegetables (Brassica oleracea)
Definition
Scientific Findings
Bioactive Dose
Safety
Brazil Nut (Bertholletia excelsa)
Definition
Scientific Findings
Bioactive Dose
Safety
Broccoli (Brassica oleracea L. var. italica)

Citation preview

The A-Z Guide to Food as Medicine Second Edition

The A-Z Guide to Food as Medicine Second Edition

Diane Woznicki Kraft, M.S., R.D.N., L.D.N.

CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2019 by Taylor & Francis Group, LLC CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works Printed on acid-free paper International Standard Book Number-13: 978-1-138-59579-8 (Paperback) This book contains information obtained from authentic and highly regarded sources. Reasonable efforts have been made to publish reliable data and information, but the author and publisher cannot assume responsibility for the validity of all materials or the consequences of their use. The authors and publishers have attempted to trace the copyright holders of all material reproduced in this publication and apologize to copyright holders if permission to publish in this form has not been obtained. If any copyright material has not been acknowledged please write and let us know so we may rectify in any future reprint. Except as permitted under U.S. Copyright Law, no part of this book may be reprinted, reproduced, transmitted, or utilized in any form by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying, microfilming, and recording, or in any information storage or retrieval system, without written permission from the publishers. For permission to photocopy or use material electronically from this work, please access www. copyright.com (http://www.copyright.com/) or contact the Copyright Clearance Center, Inc. (CCC), 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400. CCC is a not-for-profit organization that provides licenses and registration for a variety of users. For organizations that have been granted a photocopy license by the CCC, a separate system of payment has been arranged. Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRC Press Web site at http://www.crcpress.com

Contents Foreword............................................................................................................xv Preface.............................................................................................................. xvii Acknowledgments...........................................................................................xxi Author............................................................................................................. xxiii Chapter A............................................................................................................. 1 Açaí Berry (Euterpe oleracea)............................................................................... 1 Alfalfa (Medicago sativa)...................................................................................... 2 Allium Vegetables............................................................................................... 3 Allspice (Pimenta dioica)...................................................................................... 4 Almond (Prunus dulcis)....................................................................................... 5 Anise (Pimpinella anisum)................................................................................... 6 Anthocyanins...................................................................................................... 7 Antioxidant.......................................................................................................... 8 Apple (Malus sylvestris)....................................................................................... 9 Apricot (Prunus armeniaca)............................................................................... 10 Artichoke (Cynara scolymus)............................................................................. 11 Arugula (Eruca sativa)....................................................................................... 12 Asian Pear (Pyrus pyrifolia)............................................................................... 13 Asparagus (Asparagus officinalis L.)................................................................. 14 Astaxanthin....................................................................................................... 14 Avocado (Persea americana)............................................................................... 15 References.......................................................................................................... 16 Chapter B........................................................................................................... 23 Banana (Musa paradisiaca)................................................................................. 23 Barley (Hordeum vulgare L.).............................................................................. 24 Basil, sweet (Ocimum basilicum)....................................................................... 24 Beer...................................................................................................................... 25 Beet (Beta vulgaris)............................................................................................. 27 Beta-carotene (β-carotene).................................................................................. 28 Beta-glucan (β-glucan)...................................................................................... 29 Biotin................................................................................................................... 29 v

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Bitter Orange (Citrus aurantium)...................................................................... 31 Black Currant (Ribes nigrum)............................................................................ 32 Black Pepper (Piper nigrum)............................................................................. 33 Blackberry (Rubus spp.).................................................................................... 33 Blueberry (Vaccinium spp.)............................................................................... 34 Bok Choy (Brassica campestris)......................................................................... 35 Boron................................................................................................................... 36 Boysenberry (Rubus ursinus)............................................................................ 36 Brassica Vegetables (Brassica oleracea)............................................................. 37 Brazil Nut (Bertholletia excelsa)......................................................................... 39 Broccoli (Brassica oleracea L. var. italica).......................................................... 40 Brussels Sprouts (Brassica oleracea var. gemmifera DC.)................................. 40 References.......................................................................................................... 41 Chapter C........................................................................................................... 49 Cabbage (Brassica oleracea var. capitata)........................................................... 49 Caffeine............................................................................................................... 50 Calcium............................................................................................................... 51 Cantaloupe (Cucumis melo)............................................................................... 54 Canthaxanthin................................................................................................... 54 Caper (Capparis spinosa).................................................................................... 55 Carambola (Averrhoa carambola)...................................................................... 56 Caraway (Carum carvi)...................................................................................... 57 Carbohydrate..................................................................................................... 58 Carnitine............................................................................................................. 59 Carotenoids........................................................................................................ 59 Carrot (Daucus carota L.)................................................................................... 60 Catechin.............................................................................................................. 61 Cauliflower (Brassica oleracea).......................................................................... 62 Celery (Apium graveolens)................................................................................. 62 Chamomile (Matricaria recutita [German chamomile], Chamomilla recutita [Roman chamomile])...................................................... 63 Cheese................................................................................................................. 64 Cherimoya (Annona cherimola)......................................................................... 65 Cherry, sweet (Prunus avium) and Cherry, sour or tart (Prunus cerasus)............................................................................. 66 Chia (Salvia Hispanica L.).................................................................................. 66 Chicory (Cichorium intybus).............................................................................. 67 Chive (Allium schoenoprasum)........................................................................... 68 Chocolate (Theobroma cacao)............................................................................. 69 Choline............................................................................................................... 70 Chromium.......................................................................................................... 71 Cilantro (Coriandrum sativum)......................................................................... 71 Cinnamon (Cinnamomum cassia)...................................................................... 72

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Citrus.................................................................................................................. 73 Clove (Eugenia caryophyllata)............................................................................ 74 Coconut (Cocos nucifera).................................................................................... 74 Coenzyme Q10.................................................................................................... 76 Coffee (Coffea arabica)........................................................................................ 76 Copper................................................................................................................ 77 Corn (Zea mays).................................................................................................. 78 Cranberry (Vaccinium macrocarpon)................................................................. 79 Cucumber (Cucumis sativus)............................................................................. 79 Cumin (Cuminum cyminum)............................................................................. 80 References.......................................................................................................... 81 Chapter D.......................................................................................................... 95 Dairy Foods Group........................................................................................... 95 Dandelion (Taraxacum officinale)...................................................................... 97 Date (Phoenix dactylifera)................................................................................... 98 Dill (Anethum graveolens).................................................................................. 99 Docosahexaenoic Acid................................................................................... 100 References........................................................................................................ 101 Chapter E......................................................................................................... 105 Egg..................................................................................................................... 105 Eggplant (Solanum melongena)........................................................................ 106 Eicosapentaenoic Acid.................................................................................... 107 Endive (Cichorium intybus).............................................................................. 108 Endive, Belgian (Cichorium endivia)............................................................... 109 Ethanol.............................................................................................................. 109 References.........................................................................................................111 Chapter F......................................................................................................... 115 Fatty Fish...........................................................................................................115 Fennel (Foeniculum vulgare).............................................................................116 Fenugreek (Trigonella foenum-graecum)..........................................................117 Ferulic Acid.......................................................................................................118 Feta Cheese.......................................................................................................118 Fiber...................................................................................................................119 Fig (Ficus carica)................................................................................................ 121 Flavonoids........................................................................................................ 121 Flaxseed (Linum usitatissimum)...................................................................... 123 Folate................................................................................................................. 124 Fructan.............................................................................................................. 125 Fruit................................................................................................................... 126 References........................................................................................................ 127

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Chapter G........................................................................................................ 135 Garbanzo bean (Cicer arietinum).................................................................... 135 Garlic (Allium sativum).................................................................................... 136 Ginger (Zingiber officinale)............................................................................... 137 Glucosinolates.................................................................................................. 138 Glutathione....................................................................................................... 139 Glycosides........................................................................................................ 139 Grains................................................................................................................ 140 Grains, Whole...................................................................................................141 Grape (Vitis vinifera)........................................................................................ 142 Grapefruit (Citrus paradisi)............................................................................. 143 Green Leaf(y) Vegetables............................................................................... 144 Guava (Psidium guajava).................................................................................. 145 References........................................................................................................ 146 Chapter H........................................................................................................ 151 Hazelnut (Corylus avellana)............................................................................. 151 Hemicellulose.................................................................................................. 152 Honey................................................................................................................ 152 Honeydew melon (Cucumis melo L. var. inodorus Naud).......................... 153 Hops (Humulus lupulus L.).............................................................................. 154 Horseradish (Armoracia rusticana, Cochlearia armoracia)............................. 155 References........................................................................................................ 156 Chapter I.......................................................................................................... 159 Inulin................................................................................................................. 159 Iodine................................................................................................................ 160 Iron.....................................................................................................................162 Isoflavones........................................................................................................ 163 Isoprenoids....................................................................................................... 164 Isothiocyanates................................................................................................ 165 References........................................................................................................ 165 Chapter J.......................................................................................................... 169 Jasmine Rice (Oryza sativa L.)........................................................................ 169 Jerusalem Artichoke (Helianthus tuberosus)................................................. 170 Jicama (Pachyrhizus erosus)............................................................................. 171 Juniper Berry (Juniperus communis L.).......................................................... 172 References........................................................................................................ 172 Chapter K......................................................................................................... 175 Kaempferol....................................................................................................... 175 Kale (Brassica oleraceae var. acephala)..............................................................176 Key Lime (Citrus aurantifolia)......................................................................... 177

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Kiwifruit (Actinidia chinensis)........................................................................ 178 Kombucha........................................................................................................ 178 Kumquat (Fortunella sp. Swingle, Citrus japonica var. margarita)................ 180 References........................................................................................................ 181 Chapter L......................................................................................................... 183 Lactose.............................................................................................................. 183 Legume............................................................................................................. 184 Lemon (Citrus limon)....................................................................................... 185 Lemongrass (Cymbopogon citratus)................................................................ 186 Lettuce (Lactuca sativa).................................................................................... 187 Lignan............................................................................................................... 188 Limonene.......................................................................................................... 189 Lingonberry (Vaccinium vitis-idaea)............................................................... 189 Lipid.................................................................................................................. 190 Lutein................................................................................................................ 190 Lychee Fruit (Litchi chinensis)......................................................................... 192 Lycopene (Solanum lycopersicum)................................................................... 193 References........................................................................................................ 194 Chapter M........................................................................................................ 201 Magnesium...................................................................................................... 201 Mango (Mangifera indica)................................................................................ 203 Marjoram, sweet (Origanum majorana)......................................................... 204 Mediterranean Diet......................................................................................... 205 Melatonin......................................................................................................... 206 Monounsaturated Fatty Acid........................................................................ 207 Mulberry (Morus rubrum)............................................................................... 208 Mung bean (Phaseolus aureus)........................................................................ 209 Mushroom, maitake (Grifola frondosa).......................................................... 210 Mushroom, oyster (Pleurotus ostreatus)..........................................................211 Mushroom, shiitake (Lentinus edodes)........................................................... 212 Mustard Seed (Brassica alba)........................................................................... 213 References........................................................................................................ 213 Chapter N........................................................................................................ 219 Nectarine (Prunus persica nectarina).............................................................. 219 Niacin................................................................................................................ 220 Nitrates and Nitrites....................................................................................... 221 Noni (Morinda citrifolia).................................................................................. 222 Nori (Porphyra tenera)...................................................................................... 223 Nut..................................................................................................................... 223 Nutmeg (Myristica fragrans)........................................................................... 225 References........................................................................................................ 226

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Chapter O........................................................................................................ 229 Oat (Avena sativa)............................................................................................. 229 Okra (Abelmoschus esculentus)........................................................................ 230 Olive (Olea europaea L.).................................................................................... 231 Olive Oil (O. europaea)..................................................................................... 231 Omega-3 Fatty Acids...................................................................................... 232 Omega-6 Fatty Acids...................................................................................... 234 Onion (Allium cepa).......................................................................................... 235 Orange, Sweet (Citrus sinensis)...................................................................... 235 Oregano (Origanum vulgare)........................................................................... 236 References........................................................................................................ 237 Chapter P......................................................................................................... 243 Palm (Cocos nucifera)........................................................................................ 243 Pantothenic Acid............................................................................................. 244 Papaya (Carica papaya L.)................................................................................ 245 Paprika (Capsicum annuum L.)........................................................................ 246 Parsley (Petroselinum crispum)........................................................................ 246 Passion Fruit (Passiflora edulis)....................................................................... 248 Peach (Prunus persica)...................................................................................... 249 Peanut (Arachis hypogaea)................................................................................ 249 Pear (Pyrus communis)..................................................................................... 250 Pectin................................................................................................................ 251 Pepper, chili (Capsicum frutescens, Capsicum annuum)................................ 251 Pepper, sweet bell (Capsicum anuum L.)........................................................ 252 Peppermint (Mentha x piperita)...................................................................... 253 Persimmon (Diospyros kaki)............................................................................ 254 Phenolic Compounds..................................................................................... 255 Phloretin........................................................................................................... 256 Phosphorus...................................................................................................... 257 Phytate.............................................................................................................. 258 Phytoestrogens................................................................................................ 258 Pineapple (Anasas comosus)............................................................................ 259 Pistachio (Pistacia vera)................................................................................... 260 Plantain (Musa x paradisiaca).......................................................................... 261 Plum (Prunus domestica).................................................................................. 262 Polyunsaturated Fatty Acids......................................................................... 263 Pomegranate (Punica granatum)..................................................................... 263 Potassium......................................................................................................... 264 Potato, sweet (Ipomoea batatas)....................................................................... 265 Potato, white (Solanum tuberosum)................................................................. 266 Prebiotics.......................................................................................................... 267 Prickly pear (Opuntia sp.)............................................................................... 268 Probiotics.......................................................................................................... 269

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Protease Inhibitors.......................................................................................... 270 Protein............................................................................................................... 270 Psyllium (Plantago ovate)................................................................................. 272 Pummelo (Citrus grandis)............................................................................... 273 Pumpkin (Cucurbita pepo)................................................................................274 Pumpkin Seed................................................................................................. 275 References........................................................................................................ 275 Chapter Q........................................................................................................ 287 Quercetin.......................................................................................................... 287 Quince (Cydonia oblonga)................................................................................. 288 Quinoa (Chenopodium quinoa)........................................................................ 289 References........................................................................................................ 290 Chapter R......................................................................................................... 293 Radicchio (Cichorium intybus L.).................................................................... 293 Radish (Raphanus sativus)............................................................................... 294 Raisin (Vitis vinifera)........................................................................................ 295 Raspberry, red (Rubus idaeus)........................................................................ 295 Resveratrol....................................................................................................... 296 Rhubarb (Rheum officinale).............................................................................. 297 Riboflavin......................................................................................................... 298 Rosemary (Rosmarinus officinalis).................................................................. 298 Rutabaga (Brassica napobrassica)..................................................................... 299 References........................................................................................................ 300 Chapter S......................................................................................................... 305 Sage (Salvia officinalis, Salvia lavandulaefolia)................................................ 305 Saponin............................................................................................................. 306 Selenium........................................................................................................... 307 Shallot (Allium cepa L. var. aggregatum)........................................................ 309 Snap Pea (Pisum sativum L.) and Snow Pea (Pisum sativum var. macrocarpon, Pisum sativum var. saccharatum)........................................310 Sodium...............................................................................................................311 Soybean (Glycine max)..................................................................................... 312 Spinach (Spinacia oleracea)............................................................................... 313 Squash (Curcubito pepo)....................................................................................314 Stanols, sterols................................................................................................. 315 Starchy Vegetables...........................................................................................316 Strawberry (Fragaria x ananassa).................................................................... 317 References.........................................................................................................318 Chapter T......................................................................................................... 325 Tamarind (Tamarindus indica)........................................................................ 325 Tangerine (Citrus reticulata)............................................................................ 326

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Tannin............................................................................................................... 326 Tarragon (Artemisia dracunculus)................................................................... 327 Tea (Camellia sinensis)...................................................................................... 328 Terpenoids........................................................................................................ 329 Thiamin (vitamin B1)...................................................................................... 330 Thyme (Thymus vulgaris)................................................................................ 331 Tofu................................................................................................................... 332 Tomatillo (Physalis philadelphica).................................................................... 333 Tomato (Lycopersicon esculentum)................................................................... 334 Turmeric (Curcuma longa)............................................................................... 334 Turnip (Brassica rapa)....................................................................................... 335 References........................................................................................................ 335 Chapter U.........................................................................................................343 Ugli fruit (Citrus paradisi x reticulata)............................................................ 343 References........................................................................................................ 344 Chapter V......................................................................................................... 345 Vegetables......................................................................................................... 345 Vinegar............................................................................................................. 346 Vitamin A......................................................................................................... 347 Vitamin B6........................................................................................................ 349 Vitamin B12...................................................................................................... 350 Vitamin C......................................................................................................... 352 Vitamin D......................................................................................................... 354 Vitamin E.......................................................................................................... 356 Vitamin K......................................................................................................... 357 References........................................................................................................ 358 Chapter W........................................................................................................ 367 Walnut (Juglans regia L.).................................................................................. 367 Wasabi (Wasabia japonica)............................................................................... 368 Water................................................................................................................. 369 Watercress (Nasturtium officinale).................................................................. 370 Watermelon (Citrullus lanatus)....................................................................... 371 Wheat germ...................................................................................................... 372 Wheatgrass (Triticum aestivum)...................................................................... 372 Whey................................................................................................................. 373 Wine...................................................................................................................374 References........................................................................................................ 375 Chapter X......................................................................................................... 379 Xeaxanthin....................................................................................................... 379 References........................................................................................................ 379

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Chapter Y......................................................................................................... 381 Yam (Dioscorea rotundata)............................................................................... 381 Yogurt............................................................................................................... 382 Yuca (Manihot esculenta).................................................................................. 383 References........................................................................................................ 384 Chapter Z......................................................................................................... 385 Zinc................................................................................................................... 385 Zucchini (Cucurbita pepo L.)............................................................................ 387 References........................................................................................................ 388 Appendix 1: Major Phytochemical Groups and Specific Phytochemicals Addressed in The A-Z Guide to Food as Medicine, 2nd ed...................................................................................... 389 Appendix 2: Reference Daily Intakes Used to Calculate % DVs in The A-Z Guide to Food as Medicine, 2nd ed........................................... 391 Appendix 3: Definitions of Drug Terms Used in The A-Z Guide to Food as Medicine, 2nd ed......................................................................... 393 Index................................................................................................................. 397

Foreword The link between diet and health has become increasingly clear. Epidemiological, laboratory, and human intervention studies have indicated that overall diets, as well as individual foods and food components, have the potential to both promote and mitigate chronic diseases such as cancer, metabolic syndrome, and cardiovascular disease. The increased research focus on the relationship between diet and health has led to a rapid growth in both the available scientific literature (as of this writing, a search of PubMed for the terms “diet” and “health” returned over 120,000 citations) and interest in the topic among scientists, clinicians, and the general public. While the growth in available data has shed light on many important questions, it also makes the topic difficult to approach for laypersons and scientists and clinicians new to the field, and creates the potential for erroneous interpretation, oversimplification, and deliberate misrepresentation of the conclusions of this large body of work. The A–Z Guide to Food as Medicine, 2nd Edition provides a valuable resource to the general public, as well as scientists and clinicians who are seeking a quick reference that is authoritative and scientifically-grounded in its conclusions. Key topics addressed by this volume include whole foods, spices, and individual bioactive components and nutrients. The 2nd Edition features 15 new food entries, information about FDA-defined “good sources” of nutrients, updated scientific data on bioactive doses and effects, and a useful index which allows readers to locate specific diseases and conditions in addition to the foods and food components presented in the book. Kraft’s approach in preparing this volume is highly effective. The presentation of the scientific binomial name as well as the common name of the plants discussed provides the reader with unambiguous identification. There is no confusion of whether a section on sweet potatoes (Ipomoea batatas) is actually about yams (Dioscorea spp.). The succinct definition and summary of the scientific findings for each entry make it clear to the reader what is being discussed and what has been reported. Finally, the inclusion of sections on “Bioactive Dose” and “Safety” provide answers, when data is available, to two questions frequently asked by both the general public xv

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and clinicians. Each entry is supported by numerous primary research papers, peer-reviewed review articles, and scholarly monographs. These references provide lay readers with access to the underlying literature, but are a particularly useful entrée for scientists and clinicians new to the field of food and health. The A–Z Guide to Food as Medicine, 2nd Edition is a useful addition to the scientific reference literature on the relationship between food and health. Kraft has done an outstanding job of writing a volume that is approachable by a wide audience, but provides the scientific accuracy and nuances necessary to avoid the overstated claims and popular myths that are all too common in books about this topic. I highly recommend this volume to anyone, layperson, scientist, or clinician, with an interest in the relationship between food and health. Joshua D. Lambert, Ph.D. Associate Professor of Food Science The Pennsylvania State University University Park, PA

Preface The traditional use of foods as medicine has been practiced worldwide since ancient times. In the third century BC, Hippocrates said, “Let food be thy medicine.” In the centuries that followed, records show that foods and plant materials were the basis of early medicines in practically every country.1 In contrast to the folkloric use of foods as medicine, where “an apple a day kept the doctor away” for reasons unknown, modern science: • has isolated immunomodulatory phytochemicals in apples; • is testing their effects in various disease states; • suggests a number of servings (a bioactive dose) of fruits that, in the context of a balanced diet, help to maintain health and avert disease;2 and • is observing trends in epidemiological studies (suggestive but inconclusive) in consumption of specifically white-fleshed fruits (and vegetables) and decreased rates of certain diseases. Phytochemicals, literally “plant chemicals,” are produced by the plant for survivability, that is, as protection against pathogens and pests,1 and these same bioactive ingredients impart health benefits to the consumer. For example, glucosinolates in Brassica vegetables are plant-protective2 and have been shown to exert anticancer properties when consumed.3 Major categories of health-promoting phytochemicals addressed in The Guide include: alkaloids; carotenoids; fatty acids; fibers; flavonoids; glucosinolates/indoles/isothiocyanates; phenols, phenolics; phytoestrogens/ isoflavones; plant sterols; prebiotics/probiotics; saponins; sulfides; thiols; and terpenoids. The actions of phytochemicals in the diet are characterized by Dillard and German as follows:4

1. Substrates (fuels) for biochemical reactions 2. Cofactors of enzymatic reactions 3. Inhibitors of enzymatic reactions 4. Absorbents/sequestrants that bind to and eliminate undesirable constituents in the intestine xvii

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5. Ligands (substances that bind to another molecule to form a complex) that agonize or antagonize cell surface or intracellular receptors 6. Scavengers of reactive or toxic chemicals 7. Compounds that enhance the absorption and/or stability of essential nutrients 8. Selective growth factors for beneficial gastrointestinal bacteria 9. Fermentation substrates for beneficial oral, gastric, or intestinal bacteria 10. Selective inhibitors of deleterious intestinal bacteria. A single food contains many dozens of bioactive ingredients that are beneficial to health. Phytochemicals also impart physical attributes to foods such as aroma, flavor, texture, and color. Unique phytochemicals occur in like-colored plant foods, so consumers are advised to ingest a variety of different colored fruits and likewise vegetables, as well as other plant foods, to purposefully ingest the greatest array of micronutrients, phytochemicals, and other bioactive constituents. Major public health recommendations and food guidance suggest that a plant-based diet is the optimal approach to maintaining health and preventing disease. The A-Z Guide to Food as Medicine, 2nd Edition is a dictionary of the bioactive effects of more than 250 foods, food groups, nutrients, and phytochemicals, presented in concise summaries that include: • Definition (common and historical medicinal use and characteristics important to understanding properties and function) • Scientific Findings relevant to known or potential physiological function • Bioactive Dose, when known, such as: ⚬⚬ Recommended Dietary Allowances (RDAs) and Adequate Intakes (AIs), that are daily goal amounts for micronutrient, fiber, and water intake; ⚬⚬ Acceptable Macronutrient Distribution Ranges (AMDRs) that are daily recommended amounts for the macronutrients protein, fat, and carbohydrate; and ⚬⚬ Recommended numbers of daily servings of foods from the dairy, fruit, vegetables, protein foods, and grains group • Safety data, such as Tolerable Upper Intake Levels (ULs) for nutrients, as well as adverse effects and precautionary information, when known, for foods and their non-nutrient constituents. The Guide is intended to be a clinician handbook for use by health professionals and provides consumer information according to what has been reported in the scientific literature. Only enteral, and not topical, uses of phytochemicals are addressed, and only naturally occurring foods and food constituents are addressed while dietary supplements are not,

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because their physiological effects may be due to dose; so while dietary supplements are not addressed as dictionary entries, studies using nutrient or phytochemical supplements to elicit a measurable effect may be cited. Regarding the Scientific Findings and Bioactive Dose sections, the reader is aware that in vitro and animal studies do not prove in vivo biological activity. In many cases, data about the physiological effects of a food or phytochemical are limited to laboratory research. By providing such preliminary data, The Guide is informing the reader that the research is in its infancy. Health professionals are urged to use the information to explain the current evidence base to the consumer: it would not be prudent to consider making dietary changes based on preliminary data. Rarely have individual foods or non-nutrient phytochemicals been sufficiently studied in well-designed, adequately powered clinical trials necessary to establish their physiological effects. In these many cases, a bioactive dose is not known. Bioactive doses are known for the majority of nutrients, fiber, and for certain food groups; they are intended to be used as daily intake goal amounts by healthy adults for the age ranges specified. The Guide features diet and nutrition information indexed with easyfind, alphabetical tabs, and the Index, in addition to listing food constituents, has been updated to include diseases and conditions. New to the 2nd edition are more than a dozen new foods, updated Scientific Findings sections, and the addition of several nutrients: The Guide now addresses all nutrients that have a Dietary Reference intake. Nutrient entries feature “good” and “excellent” food sources and corresponding % DVs are displayed. The Guide is a comprehensive vitamin, mineral, and macronutrient resource that summarizes sources, dose, deficiency, and assessment data. Most whole foods are known to be safe as long as the caveats of good science and common sense are observed:1 1. Most common foods and food constituents are Generally Recognized as Safe by FDA and therefore known to be safe when properly prepared and consumed in normal amounts. However, some can interact with prescription drugs and some should not be consumed when certain diseases or conditions exist. Some foods must also be avoided in cases of food intolerance, sensitivity, or allergy. 2. Phytochemicals and food constituents that are medicinal in nature in small quantities may be deleterious to health in large quantities, and, when harmful levels are known, they are included in the Safety section of each entry.

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3. All data provided in The Guide are intended to enhance diet and nutrition knowledge in keeping with clinical nutrition evidencebased practice guidelines that will educate consumers to improve their proficiency in communicating with their physicians on dietrelated decision-making. 4. Non-nutrient phytochemicals, such as flavonoids and antioxidants, are probably best utilized by the body when provided as part of the whole food matrix rather than as individual entities. The whole food is preferable as a source of nutrients and phytochemicals (with few exceptions), as opposed to taking a concentrated source of a nutrient or phytochemical via a dietary supplement, unless advised to do so by a physician. This is because the numerous symbiotic elements contained within foods are working in concert with one another, both enhancing the beneficial elements and diluting the less desirable elements. Diane Woznicki Kraft, M.S., R.D.N., L.D.N.

References





1. Conversation with Dr. Ara Der Marderosian, April 15, 2016. 2. U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2010. 7th Edition, Washington, DC: U.S. Government Printing Office, December 2010. 3. Joseph JA, Shukitt-Hale B, Willis LM. Grape Juice, Berries, and Walnuts Affect Brain Aging and Behavior. J Nutr. 2009;139:1813S–1817S. 4. Björkman M, Klingen I, Birch AN, Bones AM, Bruce TJ, Johansen TJ, Meadow R, Mølmann J, Seljåsen R, Smart LE, Stewart D. Phytochemicals of Brassicaceae in plant protection and human health—influences of climate, environment and agronomic practice. Phytochemistry. 2011;72(7):538–556. 5. Kumar G, Tuli HS, Mittal S, Shandilya JK, Tiwari A, Sandhu SS. Isothiocyanates: a class of bioactive metabolites with chemopreventive potential. Tumour Biol. 2015;36(6):4005–4016. doi: 10.1007/s13277-015-3391-5. Epub 2015 Apr 3.I 6. Dillard CJ, German JB. Phytochemicals: nutraceuticals and human health. J Sci Food and Agric 2000;80(12):1744–1756.

Acknowledgments The author gratefully acknowledges Editor Randy Brehm for this opportunity; long-time colleague and coauthor on The A–Z Guide to Food as Medicine, 1st Edition, Dr. Ara Der Marderosian; and the following people who supported the development of this book: Rosemarie Chinni, Molly Corrigan, Lianne Derrick, Gabriel Hochenberger, Mark Kaufman, Kevin Kraft, Ned Kraft, Noah Kraft, Penny M. KrisEtherton, Joshua Lambert, Martin Laplante, Bryan Moloney, Ronald McColl, Sharon Neal, Bethany Pepe, Todd Perry, Laura Piedrahita, Sheila Riley, Melisa Rivera, Donna Santos, Derek Smith, Sherry Tanumihardjo, Taylor Thomas, Martin Pettitt, and Lisa Venkler.

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Author Diane Woznicki Kraft , M.S., R.D.N., L.D.N., holds a Master of Science degree in Clinical Nutrition from New York University and a Bachelor of Science degree in Human Nutrition from Penn State. Kraft is a nutrition educator at Alvernia University in Reading, PA. She has written or been quoted on nutrition in over 100 consumer nutrition articles, including in USA Today,  and has edited chapters in science text books, including the dietary supplement chapter of The Merck Manual . With colleague Ara Der Marderosian, Kraft coauthored The A-Z Guide to Food As Medicine,  nutrition book recipient of a 2017 American Library Association Outstanding Academic Title award. The updated Guide  is a nutrition reference for healthcare professionals that addresses physiological aspects of foods, food groups, nutrients, and phytochemicals.

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Açaí Berry (Euterpe oleracea)

Definition Small, dark purple fruit of the South American açaí palm known for its antioxidant properties due to constituents such as polyphenols.1,2 Available as a pure juice but typically sold mixed with other juices as a juice blend, pureed, or in dehydrated, powdered form.

Scientific Findings In laboratory testing, açaí juice inhibited low-density lipoprotein (LDL) oxidation and exerted an antioxidant potency greater than cranberry juice but less than pomegranate juice.3 Açaí pulp reduced hypercholesterolemia in animal models.4 In healthy human volunteers (n = 12), açaí berry juice and pulp significantly increased plasma antioxidant capacity measured 12 and 24 hours after consumption, but it did not affect several other markers of antioxidant activity, such as urine antioxidant capacity.5 A small, openlabel study of healthy overweight adults (n = 10) found that consuming 100 g (approximately ½ a cup) of açaí pulp for one month reduced mean plasma fasting insulin levels, total cholesterol, and post-prandial plasma glucose.2 Açaí berry is an excellent source of vitamin A and a good source of vitamin C and potassium.6

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Alfalfa (Medicago sativa)

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Alfalfa (Medicago sativa) Definition Legume that yields seeds which are made into tea and used medicinally,7 and sprouts that are eaten fresh, stir-fried, and juiced. The major bioactive components of M. sativa include saponins, flavonoids, phytoestrogens, coumarins, alkaloids, amino acids, phytosterols, vitamins, digestive enzymes, and terpenes.8 M. sativa has a history of use in nervous and digestive system disorders and is an ancient plant whose name derives from the words “father of all foods.”8

Scientific Findings M. sativa has exhibited neuroprotective, hypolipemic, antioxidant, antiulcer, antimicrobial, and estrogenic properties in vitro.8,9 A small clinical trial of hypercholesterolemic subjects (n = 15) eating 40 g of alfalfa seeds three times daily with meals for 8 weeks reduced the elevated total and LDL cholesterol.10 Saponins in alfalfa seeds decreased intestinal absorption of cholesterol by promoting fecal excretion of bile in animal studies.11,12

Bioactive Dose Not known.

Safety Alfalfa herb and seed are GRAS (Generally Recognized as Safe) by the FDA; however, alfalfa seeds and sprouts have the potential for bacterial contamination and should be avoided by children, older adults, and immune-compromised individuals.13 Chronic ingestion of alfalfa seeds has been associated with increasing the symptoms of autoimmune diseases.7 Furthermore, the long-term safety of alfalfa seeds has not been adequately studied and, therefore, are not recommended.14 Alfalfa constituents may exert estrogenic effects and therefore may be unsafe during

Allium Vegetables

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pregnancy and lactation when used in amounts greater than those found in foods.7 When the alfalfa herb is prepared and used as a tea as described above, it is presumed to be safe for use by adults.7

Allium Vegetables

Definition Bulbous culinary herbs of the Alliaceae family that include approximately 500 species, such as onions (Allium cepa), shallots (Allium ascalonicum) garlic (Allium sativum), green onions (Allium macrostemon), leeks (Allium porrum), scallions (Allium tartaricum), chives (Allium schoenoprasum) and others. Their pungent flavor and odor, whether eaten fresh or cooked, are due to organosulfur compounds, such as allyl derivatives,15 which are also thought to be largely responsible for allium health attributes; and they are also a source of quercetin, a flavonoid.16 Allium vegetables have been used for medicinal purposes throughout recorded history to increase longevity, stamina, and strength, and as an antiparasitic agent, antiseptic, antimicrobic, antipyretic, and analgesic.17

Scientific Findings Allyl derivatives inhibited carcinogenesis in the stomach, esophagus, colon, mammary gland, and lungs of experimental animals and improved immune function, reduced blood glucose, and conferred radioprotection and protection against microbial infection.18 A population-based, casecontrol study (n = 238 case subjects with confirmed prostate cancer and 471 control subjects), found that men who consumed the highest amount of allium vegetables (>10.0 g/day which is approximately 1 tablespoon19)

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Allspice (Pimenta dioica)

had a statistically significant lower risk of prostate cancer than those who consumed the lowest amount of allium vegetables daily.20 Allium vegetable intake of > or = 1 portion per week compared with low or no consumption was associated with a reduced risk of myocardial infarction (MI) in a case-control study (n = 760 patients with a first episode of non-fatal acute MI and 682 controls).21 High allium vegetable consumption was associated with a reduced risk of gastric cancer in a meta-analysis of 19 casecontrol and two cohort studies (n = 543,220).22 In a multicenter case-control study, a comparison of dietary data from 454 endometrial cancer cases and 908 controls found “a moderate protective role of allium vegetables on the risk of endometrial cancer.”23 A large prospective population-based cohort study (n = 1,226 older women) followed subjects free of atherosclerotic vascular disease (ASVD) and diabetes for 15 years and found that 6.2 g/day allium vegetable intake (approximately = to 1 ½ teaspoons24) was strongly associated with a lower risk of ASVD mortality and inversely associated with ischemic heart disease mortality and ischemic cerebrovascular disease mortality.25

Bioactive Dose Small amounts of allium vegetables, ranging from 6.2 g/day (approximately 1 ½ teaspoons) to 10 g/day (approximately 1 tablespoon) have been associated with decreased risk of atherosclerotic vascular disease and prostate cancer risk, respectively.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Allspice (Pimenta dioica) Definition Dried fruit of a Caribbean tree26 that is ground into a reddish-brown powder and consumed as a spice. Allspice is used in Caribbean cooking as jerk seasoning; in Indian chutneys, biryani, and meat and poultry dishes; in Middle Eastern cooking; and is a component of pumpkin pie spice. Pimenta dioica contains numerous phytochemicals including phenolics, vanillin, eugenol, and terpenoids.27 In traditional medicine, allspice has been used to treat hypertension, inflammation, pain, diarrhea, fever, cold, pneumonia, and bacterial infection.30

Almond (Prunus dulcis)

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Scientific Findings Laboratory studies have shown allspice to have antioxidant properties.28,29 A review of allspice found its glycosides and polyphenols exerted antibacterial, hypotensive, anti-neuralgic, and analgesic properties in laboratory studies; in addition, in vitro and in vivo studies showed it to have antiprostate-cancer and anti-breast-cancer properties, as well as to exhibit “selective antiproliferative and anti-tumor properties on human cancer cells and their animal models.”

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Almond (Prunus dulcis) Definition Tree nut, also known as sweet almond, that is typically eaten roasted and in candy and baked products, pureed as almond butter, and made into milk. Almonds are a source of protein, alpha-tocopherol, manganese, magnesium, copper, phosphorus, and riboflavin,30 in addition to fiber, phytosterols, and polyphenolic compounds, such as proanthocyanidins and lignans.31 Almond fat is mostly monounsaturated;32 approximately 50% of an almond’s weight is fat.33 Per 8 oz, almond milk supplies 450 mg of calcium and 3.75 µg (150 IU) of vitamin D compared to cow’s milk that supplies 276 mg of calcium and 3 µg (124 IU) of vitamin D.33

Scientific Findings When consumed as part of a low saturated fat diet, low cholesterol diet, 2.5–3.5 oz (70–100 g) of almonds reduced total cholesterol by 4–11% and LDL by 7–12%, according to the results of five small human studies, two of which also found a 1.7% to 3.5% increase in HDL cholesterol.34 Conversely, a 22-week randomized, controlled crossover-design trial of coronary artery disease patients (n = 145) found that the addition of almonds to a cholesterol-lowering diet regimen did not significantly

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Anise (Pimpinella anisum)

impact vascular function, lipid profile, or systematic inflammation.35 Despite nuts’ general reputation of being high-calorie, two randomized, controlled trials (RCTs) found that a low-calorie diet which included almonds did not increase body weight. In one of the studies (n = 123), overweight and obese individuals were randomly assigned to consume either an almond-supplemented low-calorie diet or a nut-free low-calorie diet. At 18 months, both groups experienced clinically significant and comparable weight loss.36 In the second study (n = 65), subjects were randomized to a liquid formula-based weight-loss diet supplemented with almonds, or a liquid formula-based weight-loss diet supplemented with complex carbohydrates. At 24 weeks, greater reductions in weight were seen in the almond-supplemented group.37 Both studies found improvements in blood lipids in almond-supplemented groups compared to control groups.36,37 In a third, non-placebo-controlled study (n = 20), healthy women added almonds to their diet for 10 weeks, followed by a 3-week washout period, followed by their usual diet without almonds for another 10 weeks. The study found that “10 weeks of daily almond consumption did not cause a change in body weight,” which was attributed to “compensation for the energy contained in the almonds through reduced food intake from other sources.”38

Bioactive Dose Scientific evidence suggests, but does not prove, that eating 1.5 oz per day of most nuts, such as almonds, as part of a diet low in saturated fat and cholesterol may reduce the risk of heart disease.39

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Anise (Pimpinella anisum) Definition Anise seeds are used as a spice and to flavor liqueurs. Though anise seeds are commonly consumed after meals to freshen breath and to induce burping, which is thought to occur because a constituent in anise reduces the surface tension of the stomach contents, resulting in gas bubble coalescence and release.

Anthocyanins

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Scientific Findings Anise demonstrated antimicrobial, antifungal, antiviral, antioxidant, immunostimulant, muscle relaxant, analgesic, and anticonvulsant activity, reduced morphine dependence, antagonized Helicobacter pylori, and exerted cytotoxic activity in human prostate cancer cells in vitro.40–43

Bioactive Dose For antiflatulence, an oral dose of 1 tablespoon of the tea, prepared by steeping 1–2 teaspoons of the crushed seed for 10–15 minutes and then straining, taken several times a day.7

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Anthocyanins Definition Purple or red plant antioxidant food pigments, found in foods such as berries, black currant, blueberry, cherry, cranberry, eggplant, lingonberry, mulberry, lettuce, and strawberry.44 Chemically classified as polyphenolic compounds, examples of anthocyanins include cyanidin, malvidin, and petunidin.45 Used in folk medicine to treat liver dysfunction, hypertension, vision disorders, microbial infections, diarrhea, and other disorders.45

Scientific Findings In laboratory research, anthocyanins demonstrated estrogenic activity that altered the development of hormone-dependent disease symptoms; increased cytokine production, thus regulating immune response; reduced capillary permeability and fragility and strengthened membranes; exerted anti-inflammatory, antidiabetic, and antimicrobial properties; and demonstrated anticancer and antiproliferative capabilities. A comprehensive review of eight prospective, controlled interventional and observational studies (n = 390,769 participants) found no evidence to suggest that a high anthocyanin intake is inversely associated with colorectal adenomas.46

Bioactive Dose Not known.

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Antioxidant

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Antioxidant Definition Phytochemicals that can prevent, inhibit, or repair damage caused by oxidative stress. Antioxidants may interfere with oxidation by inactivating a prooxidant compound, scavenging free radicals, acting as chelators to inactivate metal catalysts, repairing oxidative damage, or stimulating the activity of antioxidant enzymes.47,48 All plant foods are sources of antioxidants, which include carotenoids; vitamin C, vitamin E, and selenium; isothiocyanates; and phenolic compounds (flavonoids, stilbenes, phenolic acids, and lignans).48

Scientific Findings Epidemiological data suggest that the intake of foods rich in vitamin E, C, and beta-carotene is associated with a decreased risk for coronary heart disease.49 Studies support a beneficial effect of food-derived beta-carotene, vitamin C, vitamin E, lutein, and xeaxanthin in delayed progression of advanced age-related macular degeneration; while other studies have reported inconclusive findings.49 A measure of the antioxidant capacity of a diet called dietary total antioxidant capacity has been shown to be inversely associated with risks of developing common chronic diseases, and was found to be a good predictor of dietary and plasma antioxidant status in a sample of healthy, young adult men and women (n = 60 nonsmoking adults aged 16–25).51

Bioactive Dose Not known and/or varies by antioxidant (See: Bioactive Dose for Selenium, Vitamin C, and Vitamin E—each has an RDA. Note beta-carotene has no RDA).

Safety Varies by antioxidant (See: Safety for Selenium, Vitamin C and Vitamin E— each has a UL.) Beta-carotene has no UL.

Apple (Malus sylvestris)

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Apple (Malus sylvestris) Definition Member of Rosaceae family and popular snack fruit that is available dehydrated, dried, and as sauce, juice, and cider. There are thousands of varieties of apples having fairly similar nutritional profiles. Their polyphenol content varies greatly from one variety to another and include monomers (e.g., chlorogenic acid and catechins), flavonoids (e.g., quercetin glycosides and other flavonoids), and tannins, such as procyanidins.52 Apple pulp and cloudy apple juice are sources of the soluble fiber pectin,53,54 while apple peel contains insoluble fiber.55 Applesauce has been traditionally used to treat diarrhea as part of the BRAT (bananas-rice-applesauce-toast) diet.56

Scientific Findings Pectin may reduce diarrhea by stimulating epithelial growth in the colon.57 Soluble fibers slow upper gastrointestinal transit time, increase fecal water-holding ability, and promote excretion of bile acids and cholesterol. Insoluble fibers provide bulk and promote the excretion of stool. Total and LDL cholesterol were reduced in a randomized, double-blind, placebo-controlled study (n = 71 healthy, moderately obese adults) in subjects ingesting 600 mg of apple polyphenols for 12 weeks, an effect not seen in the placebo group.58 In a one-year clinical trial (n = 160 postmenopausal women), consumption of 75 g dried apple (about two mediumsized apples) was found to significantly reduce atherogenic cholesterol levels in the third month.59 A non-randomized trial of healthy subjects (n = 23) found that apples, but not apple juice, significantly reduced total and LDL cholesterol.60 Epidemiologic studies suggest an inverse relationship between apple consumption and colon cancer risk54 and that regular consumption of one or more apples a day may reduce the risk for lung and colon cancer.61 Apples and apple products have been associated with beneficial effects on the risk, markers, and etiology of cancer, cardiovascular disease, asthma, and Alzheimer’s Disease.62 A prospective, populationbased cohort study (n = 20,069 men and women aged 20 to 65 years free of cardiovascular diseases at baseline) found that a high intake of whitefleshed fruits may protect against stroke. Each 25-g/day (approximately ¼ of a cup) increase in white fruit (and vegetable) consumption was associated with a 9% lower risk of stroke.63 In a laboratory analysis, apple extracts showed strong antioxidant activity.64 Apple cider vinegar had no

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Apricot (Prunus armeniaca)

effect on postprandial plasma glucose and insulin in a small, randomized clinical trial (n = 30 subjects with Type II diabetes) where half of the group received apple cider vinegar and water and the other half received water alone after each consuming 58 g of carbohydrate.65 Procyanidins favorably modulate cancer-related processes in animal research and in vitro.52 Anthocyanidins in cloudy apple juice antagonized colon carcinogenesis in vivo,54 but apple juice was not cancer-preventative in a study of obese rats.54

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Apricot (Prunus armeniaca) Definition Small stone-fruit member of the Rosaceae family that supplies, per four apricots (a standard serving): 2.8 g of fiber (10% DV), 14 mg of vitamin C (15% DV), and 2696 IU of vitamin A (89% DV) and phytochemicals including flavonoids.66–68 In folk medicine, apricots have been used to treat hemorrhage, infertility, eye inflammation, and spasm.69

Scientific Findings Apricots bound bile acids in an in vitro study.70 Soluble fiber binds bile acids and cholesterol in the intestine, promoting their excretion, thereby reducing serum cholesterol.

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Artichoke (Cynara scolymus)

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Artichoke (Cynara scolymus)

Definition Herb whose name derives from the Greek word cynara meaning “dog” that refers to the spines on the flowering head resembling a dog’s tooth.71 Removal of the artichoke’s outer leaves reveal petals with edible bases, held in place by a core (artichoke “heart”) that is the main edible portion. Artichokes are cooked by steaming or boiling, but jarred artichokes, packed in salt water or pickled, are commonly eaten in salads. Artichoke hearts contain both soluble and insoluble fiber and are a good source of fiber, vitamin C, folate, and magnesium.72 Artichoke’s phytochemicals include caffeic acid and flavonoids.73

Scientific Findings A meta-analysis of three randomized, placebo-controlled clinical trials (n = 262 patients with hypercholesterolemia) concluded that artichoke leaf extract may have cholesterol-lowering potential.74 In a 6-week, double-blind, randomized controlled trial (n = 247 patients with functional dyspepsia), a dose of 640 mg of artichoke leaf extract reduced dyspepsia compared to placebo.75 In a randomized, crossover-design study (n = 8 healthy subjects and n = 19 subjects with metabolic syndrome), glucose, insulin, and homocysteine levels were measured postprandially every four hours after a meal containing boiled wild artichoke, white bread,

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Arugula (Eruca sativa)

refined olive oil, and lemon juice, and a control meal that did not contain boiled artichoke. The boiled artichoke meal, compared with the control meal, reduced postprandial serum glucose and insulin response in normal subjects but had no effect on patients with metabolic syndrome or on homocysteine levels in either group.76

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Arugula (Eruca sativa) Definition Also called “rocket,” this aromatic Brassicacea salad green makes a distinctively earthy tasting salad or may be finely chopped and combined with garlic, parmesan cheese, and seasonings to make pesto. A good source of vitamin K77 and glucosinolates.78 Eruca sativa seed extract has been used to treat skin disorders in traditional Middle Eastern medicine.79 Arugula seeds are used to grow microgreens used in salads and as a garnish.

Scientific Findings Arugula (Eruca sativa cv. Sky) extract exhibited antioxidant properties in vitro in human colon cancer cells.80

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Asian Pear (Pyrus pyrifolia)

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Asian Pear (Pyrus pyrifolia)

Definition Crisp-fleshed, juicy pear, sometimes called Asian apple pear or Japanese pear. It resembles a yellow apple with rough, sandpaper-like skin, and it tastes like a watered-down apple.81 A source of malaxinic acid, a phenolic acid compound found mainly in pears, and they contain 4 g fiber (14% DV) per medium fruit.82,83

Scientific Findings In laboratory research, Pyrus pyrifolia cv. Shingo (Korean pear), a specific variety or cultivar of Asian pear, stimulated two key alcohol-metabolizing enzymes involved in alcohol detoxification.84 Phenolics have been found to have numerous potent beneficial biological effects in laboratory studies.

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by non-allergic individuals.

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Astaxanthin

Asparagus (Asparagus officinalis L.) Definition Green shoot vegetable (the spears are “shoots”) that is commonly eaten after boiling or steaming. Asparagus is a good source of vitamin K and folate,85 and contains numerous phytochemicals, including flavonoids86 and saponins.87 The mineral content (copper, iron, zinc, manganese, calcium, magnesium, sodium, potassium, and phosphorous) is higher in green asparagus than in other varieties, and nutrients are generally richest in the tips of the spears. Asparagus has been used in traditional medicine as a diuretic and contraceptive.86,88

Scientific Findings In laboratory studies, asparagus has exhibited antifungal, antiviral, and antitumor properties attributed to steroidal saponins.87 In an 8-week animal study, an asparagus extract reduced total and LDL cholesterol and raised HDL cholesterol in mice fed a high-fat diet to induce hyperlipidemia; in addition, antioxidative effects and normalization of animals’ liver function tests were attributed to the asparagus extract.89 The Asparagus racemosus species of asparagus, commonly used in the manufacture of dietary supplements of asparagus,90 exhibited diuretic properties in an experimental study of laboratory animals that compared asparagus to furosemide, a diuretic medication.

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals. Should not be consumed in quantities greater than are normally eaten in the diet during pregnancy due to its history of use as a contraceptive, or during lactation due to insufficient reliable information about the safety of asparagus consumed in amounts greater than those found in food during breastfeeding. Eating asparagus caused urticaria, dysphagia, dyspnea, anaphylaxis, and skin lesions in sensitized individuals.

Astaxanthin Definition Naturally occurring antioxidant that imparts the characteristic pink pigment to shrimp, lobster, and salmon, and is added as a colorant to

Avocado (Persea americana)

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farm-raised crustaceans and salmon.91 A 200-gram portion of salmon contains approximately 1–7 mg of astaxanthin.92

Scientific Findings In laboratory studies, astaxanthin reduced oxidative stress and inflammation, enhanced immune response, exhibited cardioprotective properties, and inhibited cancer cell growth.92

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Avocado (Persea americana) Definition Fruit commonly consumed fresh in salads and sushi, and as the main ingredient in guacamole. Avocado is an excellent source of folate, is high in monounsaturated fat, and is a source of the phytochemicals lutein, xeaxanthin, and beta-sitosterol, supplying 114 mg of beta-sitosterol per cup of commercial variety avocado and 175 mg per cup of California avocado.93–96 Due to its high-fat content, avocado is considered to be a high-calorie fruit.

Scientific Findings The oils in avocado may theoretically promote absorption of fat-soluble vitamins that are consumed in the same meal. Consuming 200 g/day of avocado as part of a low-calorie diet did not compromise weight loss when subjects (n = 61, mean Body Mass Index [BMI] of 32) substituted it for 30 g of mixed dietary fat.97 In a controlled clinical trial (n = 15 normolipemic and 30 hypercholesterolemic subjects), all subjects received an avocadoenriched diet. The avocado-enriched diet reduced total cholesterol after 7 days in normolipemic subjects and significantly reduced total cholesterol in hyperlipemic subjects.98

Bioactive Dose Not known.

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References

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

References 1. Neri-Numa IA, Soriano Sancho RA, Pereira APA, Pastore GM. Small Brazilian wild fruits: Nutrients, bioactive compounds, health-promotion properties, and commercial interest. Food Res Int. 2018 Jan;103:345–360. 2. Udani JK, Singh BB, Singh VJ, Barrett ML. Effects of Açai (Euterpe oleracea Mart.) berry preparation on metabolic parameters in a healthy overweight population: a pilot study. Nutr J. 2011;10(45):1–7. 3. Seeram NP, Aviram M, Zhang Y, Henning SM, Feng L, Dreher M, Heber D. Comparison of antioxidant potency of commonly consumed polyphenolrich beverages in the United States. J Agr Food Chem. 2008;56(4):1415–1422. 4. de Souza MO, Silva M, Silva ME, Oliveira P, Pedrosa ML. Diet supplementation with acai (Euterpe oleracea Mart.) pulp improves biomarkers of oxidative stress and the serum lipid profile in rats. Nutrition. 2010 Jul–Aug;26(7–8):804–810. 5. Mertens-Talcott SU, Rios J, Jilma-Stohlawetz P, Pacheco-Palencia LA, Meibohm B, Talcott ST, Derendorf H. Pharmacokinetics of anthocyanins and antioxidant effects after the consumption of anthocyanin-rich acai juice and pulp (Euterpe oleracea Mart.) in human healthy volunteers. Agric Food Chem. 2008;56(17):7796–7802. 6. US United States Department of Agriculture. Agricultural Research Service. USDA Branded Food Products Database. Acai berry puree. https​://nd​b.nal​. usda​.gov/​ndb/f​o ods/​s how/​4 5231​754?f​gcd=&​m anu=​& form​at=&c​ount=​ &max=​2 5&of ​ f set=​ & sort​ = defa​ u lt&o​ r der=​ a sc&q​ looku​ p =aca ​ i+ber ​ r y+pu​ ree&d​s=&qt​=&qp=​&qa=&​qn=&q​=&ing​= and https​://nd​b.nal​.usda​.gov/​ ndb/f​oods/​show/​45234​054?f​gcd=&​manu=​&form​at=&c​ount=​&max=​25&of​ fset=​&sort​=defa​ult&o​rder=​asc&q​looku​p=aca​i+ber​ry+ju​ice&d​s=&qt​=&qp=​ &qa=&​qn=&q​=&ing​=. Accessed May 23, 2018. 7. Jellin JM, Worthington M. Natural Medicines. Therapeutic Research Faculty. 2018. https​://na​t ural​medic​ines.​thera​peuti​crese​arch.​com/. Accessed April 1, 2018. 8. Bora KS, Sharma A. Phytochemical and pharmacological potential of Medicago sativa: a review. Pharm Biol. 2011;49(2):211–220. 9. Farsani MK, Amraie E, Kavian P, Keshvari M. Effects of aqueous extract of alfalfa on hyperglycemia and dyslipidemia in alloxan-induced diabetic Wistar rats. Interv Med Appl Sci. 2016 Sep;8(3):103–108. 10. Mölgaard J, von Schenck H, Olsson AG. Alfalfa seeds lower low density lipoprotein cholesterol and apolipoprotein B concentrations in patients with Type II hyperlipoproteinemia. Atherosclerosis. 1987 May; 65(1–2):173–179. 11. Malinow MR, Connor WE, McLaughlin P, Stafford C, Lin DS, Livingston AL, Kohler GO, McNulty WP. Cholesterol and bile acid balance in Macaca fascicularis. Effects of alfalfa saponins. J Clin Invest. 1981;67(1):156–162.

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12. Story JA, LePage SL, Petro MS, West LG, Cassidy MM, Lightfoot FG, Vahouny GV. Interactions of alfalfa plant and sprout saponins with cholesterol in vitro and in cholesterol-fed rats. Am J Clin Nutr. 1984;39:917–929. 13. Der Marderosian A, Beutler B, eds. The Review of Natural Products. 5th edn. St. Louis MO: Wolters Kluwer Health;2008. 14. NIH Medline Plus. Alfalfa. https​://me​dline​plus.​gov/d​rugin​fo/na​tural​/19. h​t ml. Accessed May 20, 2018. 15. US Department of Agriculture. Agricultural Research Service. Phytochemical Database. Allium cepa/onion. www.p​l.bar​c.usd​a.gov​/ usda​_plan​t/pla​nt_de​tail.​cfm?c​ode=7​12446​50712​44650​&plan​t_id=​396&T​h is Na​me=ps​721. Accessed January 1, 2013. 16. Formica JV, Regelson W. Review of the biology of quercetin and related bioflavonoids. Food Chem Toxicol. 1995;33(12):1061–1080. 17. Bianchini F, Vainio H. Allium vegetables and organosulfur compounds: do they help prevent cancer? Environ Health Perspect. 2001;109(9):893–902. 18. Powolny AA, Singh SV. Multitargeted prevention and therapy of cancer by diallyl trisulfide and related Allium vegetable-derived organosulfur compounds. Cancer Lett. 2008;269(2):305–314. 19. US Department of Agriculture. Agricultural Research Service. National Nutrient Database for Standard Reference Release. Onions, raw. http:​// ndb​.nal.​usda.​gov/n​db/fo​ods/s​how/3​065?m​a n=&l​facet​=&cou​nt=&m​ax=35​ &qloo​ k up=o ​ n ion&​ offse ​ t =&so​ r t=&f​ ormat ​ =Abri​ dged& ​ r epor ​ t fmt= ​ o ther​ &rptf​r m=&n​d bno=​& nutr​ient1​=&nut​r ient​2=&nu​t rien​t 3=&s​u bset​=&tot​ Count​=&mea​sureb​y=&_a​ction​_ show​=Appl​y+Cha​nges&​Qv=1&​Q5824​=0.06​ 2&Q58​ 2 5=1&​ Q 5826​ =1&Q5​ 827=1​ & Q582​ 8 =1&Q​ 5 829=​ 1&Q58​ 3 0=1&​ Q 5831​ =1&Q5​832=1​&Q583​3=10.​0. Accessed February 19, 2015. 20. Hsing AW, Chokkalingam AP, Gao YT, Madigan MP, Deng J, Gridley G, Fraumeni JF Jr. Allium vegetables and risk of prostate cancer: a populationbased study. J Natl Cancer Inst. 2002;94(21):1648–1651. 21. Grant WB. A multicountry ecologic study of risk and risk reduction factors for prostate cancer mortality. Eur Urol. 2004;45(3):271–279. 22. Zhou Y, Zhuang W, Hu W, Liu J, Wu TX, Wu XT. Consumption of large amounts of Allium vegetables reduces risk for gastric cancer in a meta-analysis. Gastroenterology. 2011;141(1):80–89. 23. Galeone C, Pelucchi C, Dal Maso L, Negri E, Montella M, Zucchetto A, Talamini R, La Vecchia C. Allium vegetables intake and endometrial cancer risk. Public Health Nutr. 2009;12(9):1576–1579. 24. US Agricultural Research Service. National Nutrient Database for Standard Reference Legacy Release. Onion. https​://nd​b.nal​.usda​.gov/​ndb/f​oods/​ show/​11282​?man=​&lfac​et=&c​ount=​&max=​25&ql​ookup​=onio​n&off​set=&​ sort=​defau​lt&fo​r mat=​Abrid​ged&r​e port​f mt=o​t her&​r ptfr​m=&nd​b no=&​ nutri​e nt1=​& nutr​i ent2​= &nut​r ient​3 =&su​b set=​& totC​o unt=​& meas​u reby​ =&Qv=​1&Q32​7718=​0.25&​Q3277​20=1&​Q3277​21=0.​66&Q3​27722​=1&Q3​27723​ =1&Q3​27724​=1&Q3​27725​=1&Q3​27726​= 0.5&​Q3277​27=0.​75&Q3​27719​=10.0​ &Qv=1​&Q327​718=0​.25&Q​32772​0=1&Q​32772​1=0.3​3&Q32​7722=​1&Q32​7723=​ 1&Q32​7 724=​1&Q32​7 725=​1&Q32​7 726=​0.5&Q​32772​7=0.7​5&Q32​7 719=​10.0. Accessed May 20, 2018.

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References

25. Blekkenhorst LC, Bondonno CP, Lewis JR, Devine A, Zhu K, Lim WH, Woodman RJ, Beilin L, Prince RL, Hodgson JM. Cruciferous and allium vegetable intakes are inversely associated with 15-year atherosclerotic vascular disease deaths in older adult women. J Am Heart Assoc. 2017 Oct 24;6(10). pii: e006558. 26. Zhang L, Lokeshwar BL. Medicinal properties of the Jamaican pepper plant pimenta dioica and allspice. Curr Drug Targets. 2012 Nov 6;13(14):1900–1906. 27. US Department of Agriculture. Agricultural Research Service. Beltsville Agricultural Research Center. Medicinal Plants Database. Pimenta dioica/allspice. www.p​l.bar​c.usd​a.gov​/usda​_plan​t/pla​nt_ho​me.cf​m. Accessed October 28, 2011. 28. Padmakumari KP, Sasidharan I, Sreekumar MM. Composition and antioxidant activity of essential oil of pimento (Pimenta dioica (L) Merr.) from Jamaica. Nat Prod Res. 2011;25(2):152–160. 29. Kikuzaki H, Sato A, Mayahara Y, Nobuji Nakatani N. G alloylglucosides from berries of Pimenta dioica. J Nat Prod. 2000, 63 (6):749–752. 30. Chen CY, Lapsley K, Blumberg J. A nutrition and health perspective on almonds. J Sci Food Agric. 2006;86:2245–2250. 31. Bolling BW, Chen CY, McKay DL, Blumberg JB. Tree nut phytochemicals: composition, antioxidant capacity, bioactivity, impact factors. A systematic review of almonds, Brazils, cashews, hazelnuts, macadamias, pecans, pine nuts, pistachios and walnuts. Nutr Res Rev. 2011;24(2):244–275. 32. US Department of Agriculture. Agricultural Research Service. Nutrient Data Laboartory. Nuts, almonds, dry roasted, without salt added. http:​// ndb​.nal.​u sda.​gov/n​db/fo​ods/s​how/3​617?f​g=&ma​n=&lf​acet=​&form​at=&c​ ount=​&max=​25&of​fset=​&sort​=&qlo​okup=​almon​d. Accessed June 27, 2013. 33. Singhal S, Baker, RD, Baker, SS. A Comparison of the nutritional value of cow’s milk and nondairy beverages. J Pediatr Gastroenterol Nutr. 2017;64(5):799–805. 34. Academy of Nutrition and Dietetics Evidence Analysis Library. What is the relationship between consuming almonds and cholesterol levels in patients with hyperlipidemia? Academy of Nutrition and Dietetics. http:​//and​evide​ nceli​brary​.com/​concl​u sion​.cfm?​concl​u sion ​_ stat​e ment ​_ id=2​50983​& high​ light​=almo​nds&h​ome=1​. Accessed May 6, 2013. 35. Chen CY, Holbrook M, Duess MA, Dohadwala MM, Hamburg NM, Asztalos BF, Milbury PE, Blumberg JB, Vita JA. Effect of almond consumption on vascular function in patients with coronary artery disease: a randomized, controlled, cross-over trial. Nutr J. 2015;17(14):61. 36. Foster GD, Leh Shantz K, Vander Veur SS, Oliver T, Lent MR, Virus A, Szapary PO, Rader DJ, Zemel BS, Gilden-Tsai A. A randomized trial of the effects of an almond-enriched, hypocaloric diet in the treatment of obesity. Am J Clin Nutr. 2012;96:249–254. 37. Wien MA, Sabaté JM, Iklé DN, Cole SE, Kandeel FR. Almonds vs complex carbohydrates in a weight reduction program. Int J Obes Relat Metab Disord. 2007 Sep;98(3):651–656. 38. Hollis J, Mattes R. Effect of chronic consumption of almonds on body weight in healthy humans. Br J Nutr. 2007;98(3):651–656. 39. US Food and Drug Administration Qualified Claim About Cardiovascular Disease Risk. Nuts & Heart Disease. www.f​ da.go​ v/Foo​ d/Lab​ eling​ Nutri​ tion/​ucm07​3992.​htm#c​ardio​. Accessed May 21, 2018.

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40. Mahady GB, Pendland SL, Stoia A, Hamill FA, Fabricant D, Dietz BM, Chadwick LRE. In vitro susceptibility of Helicobacter pylori to botanical extracts used traditionally for the treatment of gastrointestinal disorders. Phytother Res. 2005;19(11):988–991. 41. Shojaii A, Abdollahi Fard M. Review of pharmacological properties and chemical constituents of Pimpinella anisum. ISRN Pahrm. 2012;2012:510795. 42. Lee JB, Yamagishi C, Hayashi K, Hayashi T. Antiviral and immunostimulating effects of lignin-carbohydrate-protein complexes from Pimpinella anisum. Biosci Biotechnol Biochem. 2011;75(3):459–465. 43. Kadan S, Rayan M, Rayan A. Anticancer activity of anise (Pimpinella anisum L.) seed extract. Open Nutraceuticals J. 2013;6:1–5. 44. Balk E, Chung M, Raman G, Tatsioni A, Chew P, Ip S, DeVine D, Lau J. B Vitamins and berries and age-related neurodegenerative disorders. Evidence Report/Technology Assessment No. 134. (Prepared by Tufts-New England Medical Center Evidence-based Practice Center under Contract No. 290-02-0022). AHRQ Publication No. 06-E008. Rockville, MD: Agency for Healthcare Research and Quality. April 2006. 45. Lila MA. Anthocyanins and human health: an in vitro investigative approach. J Biomed Biotechnol. 2004;2004(5):306–313. http://jbb.hindawi.com. 46. Jin H, Leng Q, Li C. Dietary flavonoid for preventing colorectal neoplasms. Cochrane Database Syst Rev. 2012 Aug 15;8: CD009350. 47. Shahidi F. Natural antioxidants: an overview. In: Shahidi F, ed., Natural Antioxidants. Chemistry, Health Effects and Applications. Champaign, IL: AOCS Press; 1996:1–11. 48. Parletta N, Milteb CM, Meyer BJ. Nutritional modulation of cognitive function and mental health. J Nutr Biochem. 2013;24:725–743. 49. Academy of Nutrition and Dietetics Evidence Analysis Library. What is the relationship between eating foods rich in antioxidants and cardiovascular disease? Academy of Nutrition and Dietetics. http:​//and​evide​nceli​brary​.com/​ concl​u sion​.cfm?​concl​u sion ​_ stat​ement ​_ id=1​23&hi​g hlig ​ht=vi​t amin​%20E&​ home=​1&aut​h=1. Accessed May 6, 2013. 50. Miwa S, Nakamura M, Okuno M, Miyazaki H, Watanabe J, Ishikawa-Takano Y, Miura M, Takase N, Hayakawa Kobayashi S. Production of starch with antioxidative activity by baking starch with organic acids. Biosci Biotechnol Biochem. 2011;75(9):1649–1653. 51. Wang Y, Yang M, Lee SG, Davis CG, Koo SI, Chun OK. Dietary total antioxidant capacity is associated with diet and plasma antioxidant status in healthy young adults. J Acad Nutr Diet. 2012 Oct;112(10):1626–1635. 52. Gosse F, Guyot S, Stamatiki R, Lobstein A, Fischer B, Seiler N, Raul R. Chemopreventive properties of apple procyanidins on human colon cancerderived metastatic SW620 cells and in a rat model of colon carcinogenesis. Carcinogenesis 2005;26(7):1291–1295. 53. American Heart Association. Healthy Diet Goals. www.h​eart.​org/H​EARTO​ RG/Ge​t ting​Healt​hy/Nu​t riti​onCen​ter/H​ealth​yDiet​Goals​/Heal​t hy-D​iet-G​ oals_​UCM_3​10436​_ SubH​omePa​ge.js​p. Accessed March 30, 2013. 54. Koch TC, Briviba K, Watzl B, Fähndrich C, Bub A, Rechkemmer G, Barth SW. Prevention of colon carcinogenesis by apple juice in vivo: impact of juice constituents and obesity. Mol Nutr Food Res. 2009;53(10):1289–1302. 55. Le Marchand L, Murphy SP, Hankin JH, Wilkens LR, Kolonel LN. Intake of flavonoids and lung cancer. J Natl Cancer Inst. 2000. 19;92(2):154–160.

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56. Salfi SF, Holt K. The role of probiotics in diarrheal management. Holist Nurs Pract. 2012 May–Jun;26(3):142–149. 57. Schultz AA, Ashby-Hughes B, Taylor R, Gillis DE, Wilkins M. Effects of pectin on diarrhea in critically ill tube-fed patients receiving antibiotics. Am J Crit Care. 2000;9(6):403–411. 58. Nagasako-Akazome Y, Kanda T, Ohtake Y, Shimasaki H, Kobayashi T. Apple polyphenols influence cholesterol metabolism in healthy subjects with relatively high body mass index. J Oleo Sci. 2007;56(8):417–428. 59. Chai SC, Hooshmand S, Saadat RL, Payton ME, Brummel-Smith K, Arimandi BH. Daily apple versus dried plum: impact on cardiovascular disease risk factors in postmenopausal women. J Acad Nutr Diet. 2012;112(8):1158–1168. 60. Ravn-Haren G, Dragsted LO, Buch-Anderson T, Hensen EN, Jensen RI, Németh-Balogh M, Paulovicsocá B, Bergström A, Wilcks A, Licht TR, Markowski J, Bügel S. Intake of whole apples or clear apple juice has contrasting effects on plasma lipids in healthy volunteers. Eur J Nutr. 2012 Dec 28;52(8):1875–1889. 61. Gerhauser C. Cancer chemopreventive potential of apples, apple juice, and apple components. Planta Med. 2008;74(13):1608–1624. 62. Hyson DA. A comprehensive review of apples and apple components and their relationship to human health. Adv Nutr. 2011;2(5):408–420. 63. Oude Griep LM, Verschuren WM, Kromhout D, Ocké MC, Geleijnse JM. Stroke. Colors of fruit and vegetables and 10-year incidence of stroke. Stroke. 2011;42(11):3190–3195. 64. Kähkönen MP, Hopia AI, Vuorela HJ, Rauha J-P, Pihlaja K, Kujala TS, Heinonen M. Antioxidant activity of plant extracts containing phenolic compounds. J Agric Food Chem. 1999;47(10):3954–3962. 65. Nosrati, HR, Mousavi SE, Sajjadi P, Firoozjah AR, Moazezi Z. Effect of apple cider vinegar on postprandial blood glucose in Type 2 diabetic patients treated with hypoglycemic agents. J Babol Univ Med Sci. 2013;15(6):7–11. 66. US Department of Agriculture. Agricultural Research Center. Nutrient Data Laboratory. Apricot. www.n​al.us​da.go​v/fni​c/foo​dcomp​/sear​ch/in​dex.h​tml. Accessed October 3, 2011. 67. US Department of Agriculture. Agricultural Research Service. National Nutrient Database for Standard Reference Legacy Release. Apricot, raw. https​://nd​b.nal​.usda​.gov/​ndb/f​oods/​show/​09021​?man=​&lfac​et=&c​ount=​ &max=​2 5&ql​o okup​= apri​c ot&o​f fset​= &sor​t =def​ault&​f orma​t =Abr​idged​ &repo​r tfmt​= othe​r&rpt​f rm=&​n dbno​= &nut​r ient​1=&nu​t rien​t 2=&n​utrie​ nt3=& ​ s ubse ​ t =&to ​ t Coun ​ t =&me ​ a sure ​ b y=&Q ​ v=1&Q ​ 32601​ 3 =1&Q ​ 32601​ 4=1&Q​32601​5=4&Q​v=1&Q​32601​3=1&Q​32601​4=1&Q​32601​5=1. Accessed May 21, 2018. 68. US Department of Agriculture. Agricultural Research Service. Beltsville Agricultural Research Center. Prunus armeniaca/apricot. www.p​l.bar​c.usd​a. gov​/usda​_plan​t/pla​nt_ho​me.cf​m. Accessed October 10, 2011. 69. Yi D, Yi N, Mavi A. Antioxidant and antimicrobial activities of bitter and sweet apricot (Prunus armeniaca L.) kernels. Braz J Med Biol. 2009;42(4):346–352. 70. Kahlon TS, Smith GE. In vitro binding of bile acids by bananas, peaches, pineapple, grapes, pears, apricots and nectarines. Food Chem. 2007;101(3):1046–1051. 71. Thomsen CD, Douglas Barbe OG, Williams WA, George MR. Escaped’ artichokes are troublesome pests. Calif. Agric. 1986 Mar–Apr;40(3):7–9.

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72. Fruit and Veggies More Matters. Artichoke. www.f​ruits​andve​ggies​morem​ atter​s.org​/arti​choke​. Accessed May 21, 2018. 73. US Department of Agriculture. Agricultural Research Service. Medicinal Plants Database. Cynara scolymus. www.p​l.bar​c.usd​a.gov​/usda​_plan​t/pla​nt _ho​me.cf​m. Accessed November 14, 2011. 74. Wider B, Pittler MH, Thompson-Coon J, Ernst E. Artichoke leaf extract for treating hypercholesterolaemia. Cochrane Database Syst Rev. 2009;7(4):CD003335. 75. Holtmann G, Adam B, Haag S, Collet W, Grünewald E, Windeck T. Efficacy of artichoke leaf extract in the treatment of patients with functional dyspepsia: a six-week placebo-controlled, double-blind, multicentre trial. Aliment Pharmacol Ther. 2003;18(11–12):1099–1105. 76. Nomikos T, Detopoulou P, Fragopoulou E, Pliakis E, Antonopoulou S. Boiled wild artichoke reduces postprandial glycemic and insulinemic responses in normal subjects but has no effect on metabolic syndrome patients. Nutr Res. 2007;27(12):741–749. 77. US Department of Agriculture. Agricultural Research Service. Nutrient Data Laboratory. Arugula, Raw. http:​//ndb​.nal.​usda.​gov/n​db/fo​ods/s​how/3​ 551?q​looku​p =aru​g ula&​fg=&f​ormat​=&man​=&lfa​c et=&​m ax=2​5&new​=1. Accessed December 31, 2012. 78. US Department of Agriculture Agricultural Research Service. Phytochemical Database. Eruca sativa/arugula, rocket salad. www.p​l.bar​c.usd​a.gov​/usda​ _plan​t/pla​nt_ho​me.cf​m. Accessed October 28, 2011. 79. Yehuda H, Khatib S, Susan I, Musa R, Vaya J, Tamir S. Potential skin antiinflammatory effects of 4-methylthiobutylisothiocyanate (MTBI) isolated from rocket (Eruca sativa) seeds. Biofactors. 2009;35(3):295–305. 80. Jin J, Koroleva OA, Gibson T, Swanson J, Magan J, Zhang Y, Rowland IR, Wagstaff C. Analysis of phytochemical composition and chemoprotective capacity of rocket (Eruca sativa and Diplotaxis tenuifolia) leafy salad following cultivation in different environments. J Agric Food Chem. 2009;57(12):5227–5234. 81. Produce for Better Health. Fruit and Veggies Matter. Asian pear. www.f​ruits​ andve​ggies​matte​r.gov​/mont​h/asi​an_pe​ar.ht​ml. Accessed June 5, 2011. 82. US Department of Agriculture. Agricultural Research Service. Nutrient Data Laboratory. Asian pear. http://ndb.nal.usda.gov/. Accessed January 21, 2012. 83. Tungland BC, Meyer D. Oligo- and polysaccharides (dietary fiber): their physiology and role in human health and food. Compr Rev Food Sci Food Saf. 2002;3:90–109. 84. Lee HS, Isse T, Kawamoto T, Woo HS, Kim AK, Park JY, Yang M. Effects and action mechanisms of Korean pear (Pyrus pyrifolia cv. Shingo) on alcohol detoxification. Phytother Res. 2012;26(11):1753–1758. 85. US Department of Agriculture. Agricultural Research Center. Nutrient Data Laboratory. Asparagus, cooked, boiled, drained. www.n​al.us​da.go​v/fni​c/ foo​dcomp​/cgi-​bin/m​easur​e.pl. Accessed October 3, 2011. 86. US Department of Agriculture. Agricultural Research Service. Phytochemical Database. Asparagus oficinalis/asparagus. ww.pl​.barc​.usda​.gov/​usda_​plant​ /plan​t _det​a il.c​f m?co​de=84​20441​98420​4 4198​4 2044​19842​0 4419​8 4204​41984​ 20441​98420​4 4198​42044​19842​04419​8 4204​41984​20441​98420​4 4198​42044​19842​ 04419​84204​419&p​lant_​id=47​0&y1s​27=&T​hisNa​me=ps​721. Accessed May 15, 2013.

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87. Wang L, Wang X, Yuan X, Zhao B. Simultaneous analysis of diosgenin and sarsapogenin in Asparagus officinalis byproduct by thin-layer chromatography. Phytochem Anal. 2011;22(1):14–17. 88. Kumar MC, Udupa AL, Sammodavardhana K, Rthnakar UP, Shvetha U, Kodancha GP. Acute toxicity and diuretic studies of the roots of Asparagus racemosus Willd in rats. West Indian Med J. 2010;59(1):3–6. 89. Zhu X, Zhang W, Pang X, Wang J, Zhao J, Qu W. Hypolipidemic effect of n-butanol extract from Asparagus officinalis L. in mice fed a high-fat diet. Phytother Res. 2011;25(8):1119–1124. 90. Patil D, Gautam M, Gairola S, Jadhav S Patwardhan BHPLC/tandem mass spectrometric studies on steroidal saponins: an example of quantitative determination of Shatavarin IV from dietary supplements containing Asparagus racemosus. J AOAC Int. 2014;97(6):1497–1502. 91. Higuera-Ciapara I, Félix-Valenzuela L, Goycoolea FM. Astaxanthin: a review of its chemistry and applications. Crit Rev Food Sci Nutr. 2006;46(2):185–196. 92. Park JS, Chyun JH, Kim YK, Line LL, Chew BP. Astaxanthin decreased oxidative stress and inflammation and enhanced immune response in humans. Nutr Metab (Lond). 2010;7:18. 93. US Department of Agriculture. Agricultural Research Service National Nutrient Database for Standard Reference Legacy Release. Avocado, raw. https​://nd​b.nal​.usda​.gov/​ndb/f​oods/​show/​09037​?fgcd​=&man​u=&fo​rmat=​ &coun​t=&ma​x=25&​offse​t=&so​r t=de​fault​&orde​r=asc​&qloo​k up=a​vocad​o %2C+​raw&d​s=&qt​=&qp=​&qa=&​qn=&q​=&ing​=. Accessed May 22, 2018. 94. Dreher ML, Davenport AJ. Hass avocado composition and potential health effects. Crit Rev Food Sci Nutr. 2013;53(7):738–750. 95. US Department of Agriculture. Agricultural Research Service. National Nutrient Database. Avocado http:​//ndb​.nal.​usda.​gov/n​db/nu​trien​ts/re​ port/​nutri​entsf​r m?ma​x=25&​offse​t=0&t​otCou​nt=0&​nutri​ent1=​641&n​utrie​ nt2=&​nutri​ent3=​&subs​et=0&​fg=9&​sort=​f&mea​sureb​y=m Accessed March 23, 2015. 96. US Department of Agriculture. Agricultural Research Service. USDA Database for the Isoflavone Content of Selected Foods Release 2.0. www. a ​rs.us​da.go​v/SP2​UserF​i les/​Place​/8040 ​0525/​Data/​i sofl​av/Is​oflav​_ R2.p​d f. Accessed March 1, 2015. 97. Pieterse Z, Jerling JC, Oosthuizen W, Kruger HS, Hanekom SM, Smuts CM, Schotte AE. Substitution of high monounsaturated fatty acid avocado for mixed dietary fats during an energy-restricted diet: effects on weight loss, serum lipids, fibrinogen, and vascular function. Nutrition. 2005;21(1):67–75. 98. López Ledesma R, Frati Munari AC, Hernández Dominguez BC, Cervantes Montalvo S, Hernández Luna MH, Juárez C, Morán Lira S. Monounsaturated fatty acid (avocado) rich diet for mild hypercholesterolemia. Arch Med Res. 1996;27(4):519–523.

B

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Banana (Musa paradisiaca) Definition Popular snack fruit frequently recommended to maintain or restore blood potassium levels because it is a good source of potassium (487 mg of potassium, 10% DV) per large, 8–9-inch fruit; also a good source of fiber (3.5 g, 12.5% DV) and vitamin C (11 mg, 12% DV), and an excellent source of vitamin B6 (0.449 mg, 29% DV). Bananas contain serotonin, a precursor of melatonin.1–4 A low glycemic index food. A mainstay of the pediatric “BRAT” (bananas-rice-applesauce-toast) diet, used to reintroduce bland, easily tolerated foods when transitioning from liquids to solid food,5 although not uniformly recommended by pediatric experts for this purpose.6

Scientific Findings Green bananas and pectin significantly reduced diarrhea in a small, double-blind clinical trial (n = 62 boys aged 5–12 months with diarrhea for > 14 days) in which subjects were randomly assigned to receive either a rice-based diet (n = 21); a rice-based diet with 250 g/L of cooked green banana (n = 22); or a rice-based diet with 4 g/kg of pectin (n = 19) for 7 days. The improvement in the banana-and-pectin-supplemented group was significant compared to the rice-only group.7 Banana pulp had a cholesterol-lowering effect in laboratory rats partly attributed to soluble fiber.8 An experimental study found that 2-pentanone in banana inhibited biomarkers of colon cancer in human colon cancer cells.9

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals. A case of acute pancreatitis possibly resulting from banana allergy has been reported.10 Excessive consumption of 23

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Basil, sweet (Ocimum basilicum)

bananas (up to 20 bananas/day), with no other foods for two years, by a case subject with anorexia nervosa resulted in hyperdopaminemia, defined as whole blood dopamine exceeding the normal range of 0.5– 6.2 ng/ml.11

Barley (Hordeum vulgare L.) Definition Whole grain and a good source of fiber, barley is used to make vegetable barley soup (3.9 g fiber [14% DV] per 1 cup). Contains β-glucan, a soluble fiber, in addition to B vitamins (thiamin, riboflavin, niacin, vitamin B6, folate, pantothenic acid, and biotin), iron, zinc, phosphorus, and magnesium. When ground into smaller pieces it is called pearled barley, and barley malt, its sugar form, is used to flavor beer. In ancient Egypt barley was used as a purgative, applied to wounds to decrease healing time, decrease phlegm, and treat eye diseases. Roman gladiators believed barley bread imparted greater strength and stamina than other foods.12 In 1494, Columbus brought barley to North America.12

Scientific Findings A meta-analysis of eight trials (n = 391 patients) evaluating the effects of barley on lipids found that barley, consumed for 4–12 weeks, significantly lowered total cholesterol and triglycerides without affecting HDL.13

Bioactive Dose See: β-glucan, fiber.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals. Allergy to barley has been reported.14

Basil, sweet (Ocimum basilicum) Definition Mint family herb that contains phenolics, terpenoids, and steroids including stigmasterol and β-sitosterol.15 When it is consumed in a significant quantity rather as a culinary herb, e.g., in a ½-cup (100 g) portion of pesto (basil, garlic, parmesan cheese, and walnut made into a paste and used

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to coat cooked pasta), it supplies significant amounts of vitamins A 633 IU (20% DV) and K 50 μg (41% DV).16 Thai basil has pointed leaves and is dark green with purple pigments, especially on its stems; whereas, sweet basil is uniformly grass-green with rounded leaves. Thai basil is native to Southeast Asian cooking and is commonly sold in Asian markets, but either type of basil can be grown domestically.

Scientific Findings In laboratory studies, sweet basil cultivars exhibited an antioxidant and free radical scavenging activity attributed to their phenolic constituents.17–19 In experimental research, eugenol, a constituent in basil (as well as clove, nutmeg, cinnamon, and bay leaves) demonstrated anticancer and anti-inflammatory activity in human cervical cancer cells20 and exhibited antiproliferative and antitumor properties in human cancer cells and in animal models.21

Bioactive Dose Not known.

Safety Presumed safe when consumed by nonallergic individuals in normal dietary quantities.

Beer Definition Alcoholic beverage made from fermenting a grain, such as barley, and adding hops, also a grain, to impart the characteristic bitter flavor. Twelve oz of regular (5% alcohol) beer provides approximately 150 calories, 14 g of ethanol (alcohol), 13 g of carbohydrate, negligible micronutrients—such as niacin 1.8 mg (11% DV), potassium 96 mg (2% DV), selenium 2.1 μg (3% DV), and fluoride 157 μg (no DV)—in addition to polyphenols, which are lower in beer than in wine.22–25 Beer consumption dates to at least 5,000– 7,000 BC when wet grains combined with yeast fermented.

Scientific Findings Polyphenols, such as xanthohumol, and phytochemical metabolites in beer have exhibited anti-inflammatory, antithrombotic, antiatherogenic, antioxidant, anticarcinogenic, estrogenic, and antiviral properties in experimental research (in vitro, cell culture, enzyme assay).20 A meta-analysis of

B

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26

Beer

26 studies examining beer and vascular risk found evidence of an inverse association between light-to-moderate beer consumption and vascular disease risk.26 A systematic review of more than 35 observational studies examining the effect of beer on body weight found insufficient scientific evidence to assess whether beer intake at moderate levels (24 oz), may be positively associated with abdominal obesity.”27 Its probiotic effects are due to in part to the yeast used to make beer. Saccharomyces cerevisiae yeast reduced abdominal pain in irritable bowel syndrome (IBS) in a small, randomized, controlled, clinical trial (n = 179 adults with IBS).28

Bioactive Dose Moderate consumption has been defined as no more than one drink per day for women and no more than two drinks per day for men where a “standard” drink contains roughly 14 g of pure alcohol, found in: • 12 oz of regular beer, which is usually about 5% alcohol. • 5 oz. of wine, which is typically about 12% alcohol. • 1.5 oz of distilled spirits, which is about 40% alcohol.21

The National Institute of Alcohol and Alcoholism. What is a standard drink? National Institutes of Health National Institute of Alcohol Abuse and Metabolism (Available at: www.n​iaaa.​nih.g​ov/al​cohol​-heal​th/ov​ervie​walc​ohol-​consu​mptio​n/wha​t-sta​ndard​-drin​k)

Beet (Beta vulgaris)

27

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals. ≥2 drinks/day was associated with increased risk of colorectal cancer in a meta-analysis that included 12 case-control and nine cohort studies, while light or moderate beer drinking was not.29 The findings of a meta-analysis of 17 case-control and six cohort studies suggest that high consumption of beer, and other alcoholic beverages, was associated with an increased lung cancer risk.30 See also Ethanol.

Beet (Beta vulgaris)

Definition Also known as red beet and sugar beet. Root vegetable that supplies iron ( 3 g of β-glucans daily from oats or barley may be associated with the maintenance of normal blood cholesterol levels in adults who have normal or mild elevations of their total cholesterol levels.41 There is insufficient reliable information available about the effectiveness of β-glucans for uses other than cholesterol-lowering.42

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Biotin Definition Water-soluble vitamin that functions as a coenzyme in energy metabolism that is widely distributed naturally in foods such as meats, cereals,

B

B

30

Biotin

and fruits. Biotin is also synthesized in the intestine though not in a form that contributes significantly to absorbed biotin—perhaps less than 20% of a person’s daily requirement for biotin is from enterically synthesized biotin.43,44 Biotin intake is not routinely tracked by major food surveys but the most recently available, nationally representative data shows mean biotin intake to be higher than the RDA (approximately 39.9 μg/day for young women).43 Avidin, in uncooked egg whites, prevents biotin absorption. Consumption of raw egg white over long periods, exclusive total parenteral nutrition without biotin, short-gut syndrome, and the use of anticonvulsant medications can cause a biotin deficiency.43 Biotin deficiency symptoms include: dermatitis (red, scaly rash around the eyes, nose, and mouth), conjunctivitis, alopecia (thinning of hair and loss of hair color), and central nervous system abnormalities (depression, lethargy, hallucinations, and paresthesia of the extremities).43 Biotin deficiency can present with cutaneous findings similar to that of zinc deficiency (periorificial dermatitis with angular cheilitis),45 but often additionally manifests with hypotonia, ataxia, seizures, and hearing loss.45 Low plasma biotin concentration is not a sensitive indicator of inadequate biotin intake.43 For healthy adults, the concentration of biotin is 133–329 pmol/L in serum and 18–127 nmol/24 hours in urine. Abnormally low urinary excretion of biotin is an indicator of biotin deficiency, as is abnormally high excretion of 3-hydroxyisovaleric acid (higher than 3.3 mmol/mol creatinine) or 3-hydroxyisovalerylcarnitine (higher than 0.06 mmol/mol creatinine) resulting from the reduced activity of methylcrotonyl-CoA carboxylase (MCC). “The most reliable individual markers of biotin status, including deficiency and sufficiency, are biotinylated MCC and propionyl-CoA carboxylase in white blood cells.”46

Scientific Findings Higher than food amounts of biotin have not been shown to improve any condition except to correct for biotin deficiency.43

Bioactive Dose The AI for biotin for men and non-pregnant women 19–50 years old is 30 µg/d.43

Safety There is no UL for biotin. Toxicity has not been reported in patients treated with daily doses up to 200 mg (200,000 µg) orally and up to 20 mg (20,000 µg) intravenously.43

Bitter Orange (Citrus aurantium)

31

Bitter Orange (Citrus aurantium)

B

Definition Also known as Seville orange or sour orange. Orange that resembles a navel orange, but is too sour to be popular for eating in the US.47 Used to make marmalade, relishes, candy, and condiments.48 Bitter orange has been used in traditional or folk medicine for weight loss; to relieve nausea, indigestion, constipation, heartburn, loss of appetite, and nasal congestion; topically, it is used to treat fungal infections, such as ringworm and athlete’s foot.49

Scientific Findings Bitter orange peel extract is used in herbal weight-loss products because of its sympathomimetic, ephedra-like constituent synephrine, however, significant adverse effects have been reported to be associated with its use.50–52 Bitter orange (the food) has not been evaluated in weight reduction.49 C. aurantium fruit juice improved insulin-induced glucose uptake into adipocytes in an in vitro study.53 C. aurantium flavonoids demonstrated antiadipogenic activity in vitro.54

Bioactive Dose Not known.

B

32

Black Currant (Ribes nigrum)

Safety Bitter orange as a food is presumed safe when consumed in normal dietary quantities by nonallergic individuals, although C. aurantium may increase serum levels of drugs due to the action of its constituents on liver cytochrome p450 enzyme.48

Black Currant (Ribes nigrum) Definition Also spelled blackcurrant. High-vitamin C berry that is a significant source of anthocyanins. Used to make liqueurs, preserves, and the European beverage Ribena® which originated as a source of vitamin C for pregnant women and children when fresh fruit was scarce during World War II in Great Britain.55

Scientific Findings The effect of black currant anthocyanins on the progression of glaucoma was evaluated in a placebo-controlled, double-blind trial (n = 38 glaucoma subjects) in which subjects taking eye drops were randomized to receive either oral black currant anthocyanins (n = 19) or a placebo (n = 19) for two years. In the black currant anthocyanins group, a nonsignificant improvement in ocular blood flow, but not intraocular pressure, was observed, whereas, no effect occurred in the placebo group.56 Forty healthy subjects aged 50–70 years were randomized to receive a mixed berry (150 g blueberries, 50 g blackcurrant, 50 g elderberry, 50 g lingonberries, 50 g strawberry, and 100 g tomatoes) beverage or a volume-matched control beverage for 5 weeks. Cognitive and biochemical testing were performed. Subjects receiving the berry beverage showed a modest but significant improvement in memory testing 30 minutes after ingestion of the berry beverage compared to the control beverage, and had significantly improved total and LDL cholesterol compared to baseline and compared to the control beverage, but no change in fasting glucose or insulin concentration.57

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Blackberry (Rubus spp.)

33

Black Pepper (Piper nigrum) Definition Peppercorn of the Piper nigrum vine that is among the most-used culinary seasonings and considered “the king of spices” throughout the world due to its pungent principle piperine.58 Usually consumed in such minute quantities that nutrient intake from it is nominal.

Scientific Findings In laboratory studies, black pepper exhibited antioxidant and free radical scavenging properties.59,60 Piperine exerted beneficial, protective effects against inflammation and alveolar bone loss, supported bone microstructures and prevented collagen fiber degradation in an experimental periodontitis study.61 Experimental studies have also found Piper nigrum and its secondary metabolites to have antiapoptotic, antibacterial, anti-inflammatory, and hepatoprotective properties.58

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Blackberry (Rubus spp.) Definition High-fiber (3.8 g, 24% DV), high-vitamin C (15 mg, 16% DV) berry (values per ½ cup) that has an edible but bitter solid center. It is not the same as a black raspberry which is hollow.62 Contains polyphenolic compounds such as ellagic acid.

Scientific Findings In hypercholesterolemic animals that received either a hypercholesterolemic diet, blackberry nectar with a hypercholesterolemic diet, or a standard diet, the blackberry nectar regimen reduced triglycerides, total cholesterol, and LDL cholesterol without reducing HDL cholesterol or blood glucose concentrations, but hepatic steatosis was not prevented by the intervention.63 Ellagic acid reduced oxidative stress in laboratory studies.64,65

B

B

34

Blueberry (Vaccinium spp.)

Bioactive Dose Not known.

Blueberry (Vaccinium spp.) Definition Common sweet berry eaten fresh, frozen, dried, as a preserve, and as a constituent of mixed juice beverages. Blueberries supply vitamins A, C, and B6, thiamin, riboflavin, folate, potassium, and fiber, in addition to being abundant in flavonoids.66–68 Blueberries’ high antioxidant capacity relative to other fruits69 have made them the focus of neurological research examining blueberry flavonoids in protecting the brain from oxidative stress.58

Scientific Findings An in vitro study found that blueberries were a potent in vivo antioxidant at very low concentrations.70 Blueberry anthocyanins crossed the blood–brain barrier in an animal study and were associated with learning performance in one of the earliest experimental studies of blueberries and cognition in laboratory rats.58 A subsequent review of 21 studies found overall evidence that flavonoids benefit cognitive outcomes, such as attention and working memory in the general population, within an acute time frame of 0–6 hours after ingestion.71 The effect of blueberry supplementation on regional brain activation in older adults at risk for dementia was examined in a 16-week RCT of elderly subjects (n = 21 people aged 68 or older with mild cognitive impairment) and found that consuming a freeze-dried whole blueberry powder daily--at a dose equivalent of 1 c (approximately 148 g) whole blueberry fruit enhanced neural response but did not enhance working memory.72 A 300-g portion of blueberries (approximately 2 cups) improved cell antioxidant defense against one type of DNA damage compared to a control in a small, randomized crossover-design study (n = 10 young healthy men), but did not protect against several other markers of DNA damage or vascular function.63

Bioactive Dose Not known.

Bok Choy (Brassica campestris)

35

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Bok Choy (Brassica campestris)

Definition Also called pak choi. Hardy, green-and-white-variegated leaf vegetable usually prepared by stir-frying or sauteeing. All parts of bok choy can be consumed. First cultivated by the Chinese thousands of years ago.73 Bok choy is a good source of calcium, vitamin K, potassium, and vitamin C,74 in addition to glucosinolates such as isothiocyanates and indoles.75

Scientific Findings See: Brassica Vegetables.

Bioactive Dose Not known.

B

B

36

Boysenberry (Rubus ursinus)

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals. A case report of severe hypothyroidism with myxedema coma was reported in an elderly person who consumed 1.0 to 1.5 kg of raw bok choy daily for several months, attributed to glucosinolates in raw, uncooked Brassica foods inhibiting thyroid uptake of iodine.76

Boron Definition Essential trace mineral highest in avocado, peanut butter, peanuts, prune, grape juice, chocolate powder, wine, pecans, granola raisin cereal, and raisin bran cereals.81,82

Scientific Findings Boron plays a role in metabolic processes related to bone83 and is required for growth.81 Median consumption of boron ranged from 0.87 to 1.35 mg/day with coffee, milk, apples, dried beans, and potatoes, accounting for approximately ⅓ of US intake in a survey of the American diet.94 A clinical trial of postmenopausal women (n = 53 postmenopausal women) found that daily boron intake of 1 mg/L naturally occurring in drinking water increased serum osteocalcin levels and positively affected bone metabolism.84

Bioactive Dose No RDA has been established for boron.

Safety A tolerable upper limit of 20 mg has been established.74

Boysenberry (Rubus ursinus) Definition Hybrid berry that is a cross between a blackberry, raspberry, and loganberry.77 Commercially available as syrup, canned and frozen, and in fruit yogurt, preserves, fruit spreads, pies, and beverages. Boysenberries are rich in polyphenolic compounds (flavonoids), the main antioxidant group in berries.78

Brassica Vegetables (Brassica oleracea)

37

Scientific Findings A 4-week open-label intervention study evaluating the effect of daily boysenberry juice (180 ml/d) on vascular health parameters found positive changes in flow-mediated dilation of the brachial artery and changes in systolic blood pressure consistent with reducing cardiovascular risk.79A 4-week clinical trial (n = 25 healthy subjects) found no significant differences in quantitative measures of gut health from consuming beverages containing boysenberry.80

Bioactive Dose Not known

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Brassica Vegetables (Brassica oleracea)

Definition Also called cruciferous or mustard family vegetables. Genus consisting of many common species of cabbage family vegetables that exclusively contain glucosinolates, such as sulforaphane and indole-3-carbinol, and glucosinolate breakdown products called isothiocyanates (ITCs), in addition to polyphenols, terpenes, anthocyanins, coumarins,

B

B

38

Brassica Vegetables (Brassica oleracea)

antioxidant vitamins C and E and carotenoids, and beneficial antioxidant enzymes.85–89 Brassica is the largest and most widely consumed group of plants worldwide.88

Scientific Findings Sulforaphane exhibited chemoprotective properties in experimental research; it may prompt the body to make higher levels of chemoprotective enzymes.90 In a small clinical trial (n = 20 men with recurrent prostate cancer), treatment with 200 μmoles/day of sulforaphane-rich broccoli sprout extract did not decrease prostate-specific antigen in the majority of patients.91 Glucosinolates and Brassica-derived ITCs have exhibited anticarcinogenic and anti-inflammatory effects in vivo and in vitro,87 and “accumulating evidence increasingly supports the beneficial effects of dietary glucosinolates on overall health, including as potential anticancer agents, because of their role in the prevention of the initiation of carcinogenesis.”92 A high intake of brassica vegetables may diminish cancer risk, according to epidemiological research.93 “A high consumption of brassica vegetables is associated with a decreased risk of cancer. This association appears to be most consistent for lung, stomach, colon and rectal cancer, and least consistent for prostatic, endometrial and ovarian cancer.”93 Indole-3-carbinol’s chemoprotective properties include the induction of phase II enzymes.94 In animal studies, indole-3-carbinol exhibited chemopreventive properties.95,96 Laboratory research found that brassinin demonstrated antiproliferative effects against cancer in both in vivo and in vitro models.97

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals. A case-control study (n = 293 cases of thyroid cancer and 354 population controls) in Melanesian women found that consumption of an average of one serving (50–80 g) of cruciferous vegetables daily was associated with thyroid cancer among women with low iodine intake (31 g/day) may have negative effects on the cardiovascular system, including an increase in blood pressure, activation of the sympathetic system, and an increase in the incidence of atrial fibrillation, cardiomyopathy, and hemorrhagic stroke.27 Patients who are hypertensive should avoid alcoholic beverages.28 Alcohol can increase plasma triglyceride levels and can serve as a source of excess calories, and in patients with underlying hypertriglyceridemia, the triglyceride elevations can be marked and are associated with the development of pancreatitis.28 A deficiency of aldehyde dehydrogenase enzyme, common in Asians, “is associated with facial flushing and other unpleasant symptoms, such as light-headedness, palpitations, and nausea, when alcohol is consumed.”30 Beginning to drink alcohol or drinking more frequently on the basis of potential health benefits is not recommended because even moderate alcohol intake is associated with certain health risks, such as increased risk of breast cancer, involvement in violence, drowning, and injuries from falls, and motor vehicle accidents.25 The International Agency for Research on Cancer has classified ethanol as a human carcinogen.31

References

1. Hasler CM. The changing face of functional foods. J Am Coll Nutr. 2000;19(5 Suppl):499S–506S. 2. Institute of Medicine. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein and Amino Acids. Washington, DC: National Academy Press; 2005. 3. Egglands Best Nutrition Information. www.e​gglan​dsbes​t.com​/nutr​ition​/ nutr​ition​-fact​s.asp​x. Accessed December 20, 2011. 4. Fernandez ML. Effects of eggs on plasma lipoproteins in healthy populations. Food Funct. 2010;1(2):156–160. 5. Kritchevsky SB. A review of scientific research and recommendations regarding eggs. J Am Coll Nutr. 2004;23(6):596S–600S. 6. Academy of Nutrition and Dietetics. Review of recommendations for dietary fats and cholesterol from various organizations. www.a​ndeal​.org/​files​/file​s /DLM​_CHO_​Revie​w_201​706.p​df. Accessed June 13, 2018. 7. Pennsylvania State University College of Agricultural Sciences. Cooperative Extension Service. Upside down lunch. http:​//bet​terki​dcare​.psu.​edu/ B​KCKit​Lunch​/Lunc​hes10​3.pdf​. Accessed December 25, 2011. 8. US Department of Agriculture. Agricultural Research Service. Nutrient Data Laboratory. Eggplant, boiled. http:​//ndb​.nal.​usda.​gov/n​db/fo​ods/ s​how/3​383?f​g=&ma​n=&lf​acet=​&form​at=&c​ount=​&max=​25&of​fset=​&sort​ =&qlo​okup=​eggpl​ant. Accessed June 12, 2013. 9. US Department of Agriculture. Agricultural Research Service. Phytochemical Database. Eggplant. www.p​l.bar​c.usd​a.gov​/usda​_rrcp​/rrec​ipe_d​etail​.cfm?​ code=​69685​564&i​d=98&​ThisN​ame=s​d1. Accessed December 25, 2011. 10. Milligrams to teaspoons conversion. EasyCalculation.com. www.e​asyca​lcula​ tion.​com/u​nit-c​onver​sion/​Milli​gram-​mg-Te​aspoo​ns-ts​p.htm​l. Accessed June 13, 2018.

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References

11. Silva GE, Takahashi MH, Eik Filho W, Albino CC, Tasim GE, Serri Lde A, Assef AH, Cortez DA, Bazotte RB. Absence of hypolipidemic effect of Solanum melongena L. (eggplant) on hyperlipidemic patients. Arq Bras Endocrinol Metabol. 2004;48(3):368–373. 12. Praca JM, Thomaz A, Caramelli B. Eggplant (Solanum melongena) extract does not alter serum lipid levels. Arq Bras Cardiol. 2004;82(3):269–276. 13. Kwon Y-I, Apostolidis E, Shetty K. In vitro studies of eggplant (Solanum melongena) phenolics as inhibitors of key enzymes relevant for Type 2 diabetes and hypertension. Bioresource Technol. 2008;99(8):2981–2988. 14. Whitney ER, Rolfes SR. Understanding Nutrition. 12th edn. Belmont, CA: Wadsworth Cengage; 2011. 15. US Department of Agriculture. Agricultural Research Service. Nutrient Data Laboratory. Mullet. www.n​al.us​da.go​v/fni​c/foo​dcomp​/cgi-​bin/l​ist_ n​ut_ed​it.pl​. Accessed March 11, 2011. 16. Kris-Etherton PM, Grieger JA, Etherton TD. Dietary reference intakes for DHA and EPA. Prostaglandins Leukot Essent Fatty Acids. 2009;81(2–3):99–104. 17. Das UN. Essential Fatty acids—a review. Curr Pharm Biotechnol. 2006;7(6):467–482. 18. University of Arkansas Cooperative Extension. Endive-Escarole. www.u​aex. e​du/pu​blica​tions​/pdf/​FSA-6​068.p​df. Accessed March 13, 2015. 19. D’evoli L, Morroni F, Lombardi-Boccia G, Lucarini M, Hrelia P, Cantelli-Fort G, Tarozzi A. Red chicory (Cichorium intybus L. cultivar) as a potential source of antioxidant anthocyanins for intestinal health. Oxid Med Cell Longev. 2013;2013:704310. 20. Sultana S, Perwaiz S, Iqbal M, Athar M. Crude extracts of hepatoprotective plants, Solanum nigrum and Cichorium intybus inhibit free radical-mediated DNA damage. J Ethnopharmacol. 1995; 45(3):189–192. 21. Koudela M, Petříková K. Nutritional composition and yield of endive cultivars Cichorium endivia L. Hort Sci. 2007;34(1): 6–10. 22. Innocenti M, Gallori S, Giaccherini C, Ieri F, Vincieri FF, Mulinacci N. Evaluation of the phenolic content in the aerial parts of different varieties of Cichorium intybus L. J Agric Food Chem. 2005;53(16):6497–6502. 23. Wang FX, Deng AJ, Li M, Wei JF, Qin HL, Wang AP. (3S)-​1,2,3​,4-Te​trahy​dro-β​ -carb​oline​-3-ca​rboxy​lic acid from Cichorium endivia. L induces apoptosis of human colorectal cancer HCT-8 cells. Molecules 2012;18(1):418–429. 24. National Institutes of Health. MedlinePlus Encyclopedia. Alcohol. http:​// vse​arch.​nlm.n​ih.go​v/viv​isimo​/cgi-​bin/q​uery-​meta?​v%3Ap​rojec​t=med​linep​ lus&q​uery=​alcoh​ol. Accessed March 11, 2011. 25. US Department of Agriculture. US Department of Health and Human Services. Dietary Guidelines for Americans, 2010. 7th edn. Washington, DC: US Government Printing Office; December 2010. 26. Dimmitt SB, Rakic V, Puddey IB, Baker R, Oostryck R, Adams MJ, Chesterman CN, Burke V, Beilin LJ. The effects of alcohol on coagulation and fibrinolytic factors: a controlled trial. Blood Coagul Fibrinolysis. 1998;9(1): 39–45. 27. Markoski MM, Garavaglia J, Oliveira A, Olivaes J, Marcadenti A. Molecular properties of red wine compounds and cardiometabolic benefits. Nutr Metab Insights Cell Mol Cardiol. 2016;9:51–57.

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28. Goldberg IJ, Mosca L, Piano MR, Fisher EA. Wine and your heart: a science advisory for healthcare professionals from the Nutrition Committee, Council on Epidemiology and Prevention, and Council on Cardiovascular Nursing of the American Heart Association. Stroke. 2001;32:591–594. 29. Ehrlich D, Humpel C. Effects of ethanol on aggregation, serotonin release, and amyloid precursor protein processing in rat and human platelets. Platelets. 2013 Feb 12;25(1):16–22. 30. Thomasson HR, Edenberg HJ, Crabb DW, Mai X-L, Jerome RD, Li T-K, Wang T, Lin Y-T, Lut R-B, Yint S-J. Alcohol and aldehyde dehydrogenase genotypes and alcoholism in Chinese men. Am J Hum Genet. 1991;48:677–681. 31. Arranz S, Chiva-Blanch G, Valderas-Martínez P, Medina-Remón A, LamuelaRaventós RM, Estruch R. Wine, beer, alcohol and polyphenols on cardiovascular disease and cancer. Nutrients. 2012;4(7):759–781.

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F Fatty Fish

F

Definition Characteristically strong-flavored fish, such as bluefish, herring, salmon, trout (both wild and farmed), mackerel, sardines, and tuna, whose oils are concentrated in their edible flesh; in contrast, mild-flavored white fish, such as haddock and pollack, store their oils in their liver. Fatty fish are high in protein, vitamin D, and omega-3-fatty acids,1 and are sources of coenzyme Q10.2 Marinating with various seasonings before broiling or grilling can mask fish flavor.

Scientific Findings Fish oil constituents DHA, EPA, and vitamin D are anti-inflammatory.3–5 People who eat seafood one to four times a week are less likely to die of heart disease.6 Epidemiological studies show that the dietary intake of n-3 PUFAs through fish consumption is inversely correlated with the prevalence of depression.7 Further research is needed to determine whether EPA, DHA or fish consumption has a protective effect on all-cause dementia.8

Bioactive Dose The American Heart Association recommends eating two 3.5-oz servings of (ideally fatty) fish per week; low-mercury options include canned light tuna, salmon, anchovies, herring, shad, sardines, Pacific oysters, trout, and Atlantic and Pacific mackerel (not king mackerel, which is high in methylmercury).9,10 A daily dose of 3–4 g of EPA and DHA may reduce elevated triglyceride levels by 20–50%.11 A 6-oz portion of Atlantic salmon supplies 3.9 g of EPA and DHA.12 The Dietary Guidelines for Americans 2015–2020 recommends 8 oz of a variety of seafood weekly, for 250 mg of EPA and DHA/day, an amount associated with reduced cardiac deaths among individuals with and without preexisting CVD. For pregnant or breastfeeding women, consumption of at least 8 oz per week from seafood choices that are sources of DHA are associated with improved infant health outcomes. For children, 8 or more oz per week (less for young children) of seafood including some choices with higher amounts of EPA and 115

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Fennel (Foeniculum vulgare)

DHA is recommended. Pregnant and breastfeeding women and young children should not eat certain fish that is high in methylmercury.10

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals. Shark, swordfish, tilefish, and king mackerel (Scomberomorus cavalla), not to be confused with North Atlantic mackerel (Scomber scombrus), are considered high-methyl mercury fish and should be avoided by pregnant and lactating women. Pregnant and lactating women are also advised to limit white albacore tuna.13

Fennel (Foeniculum vulgare)

Definition Herb with a licorice-like flavor having an edible bulb, stalks, and fronds. It contains the phenolic compound anethole.14 Fennel seeds are used to flavor sausage, and fennel stalks are used raw in salad or braised or sautéed, while fronds can be used as an aromatic garnish in seafood and mushroom dishes.15

Scientific Findings Fennel experimentally improved hypertension16 and glaucoma,17 and anethole demonstrated antiplatelet aggregatory properties and provided “significant protection” from ethanol-induced gastric lesions in animal models.18 Clinical trial data suggests fennel extracts may have potential in treating infantile colic.19

Fenugreek (Trigonella foenum-graecum)

117

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Fenugreek (Trigonella foenum-graecum) Definition Plant whose leaves are used as an herb and whose seeds are used as a spice and to make flour. The first recorded use of fenugreek is described on an ancient Egyptian papyrus dated 1500 BC.20 Fenugreek has been used in traditional medicine to induce childbirth and promote lactation.20

Scientific Findings Fenugreek reduced serum glucose in diabetes experimentally and in a few small clinical trials.20,21 The gum within the fenugreek seed fiber reduces serum glucose and cholesterol.21 There is not enough evidence to support its use as a galactagogue or a pregnancy inducer.22 Fenugreek fiber significantly increased satiety in a small, single-blind, randomized trial of healthy obese patients (n = 18).23

Bioactive Dose Not known. Trials in which fenugreek was used to reduce glucose have used varying doses and delivery forms; for example, 1 g of fenugreek extract24 or 100 g of fenugreek seed powder.25 For hyperlipidemia, 0.6–2.5 g of fenugreek two times daily with meals has been used.26

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals. Possible side effects of fenugreek when taken by mouth include gas, bloating, and diarrhea.24 Since fenugreek has uterine stimulant activity, intake of amounts greater than those found in food should be avoided during pregnancy.26 Since fenugreek has not been adequately studied during lactation for potential harmful effects to the infant or mother, fenugreek should be avoided during lactation.26

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Feta Cheese

Ferulic Acid Definition Phytochemical found in seeds and leaves made from the metabolism of the amino acids phenylalanine and tyrosine.27 Found in high levels in vegetables, fruits, cereals, and coffee with the average intake estimated to be 150–250 mg/day.28

Scientific Findings In laboratory studies, ferulic acid exhibited antioxidant, antimicrobial, anti-inflammatory, antithrombotic, anticancer, and increased sperm viability effects.29,30

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals. Ferulic acid has a low toxicity potential.30

Feta Cheese Definition Soft white cheese produced by fermenting cow’s, sheep’s, or goat’s milk. It is produced in blocks and kept in brine. Feta has been, and remains, a significant element in the Greek diet traditionally produced in Greece since Homeric times.31 It is available in low- and full-fat versions, the latter is rich in vitamin K2 (menaquinone).32

Scientific Findings In a cross-sectional study (n = 407 men and women, mean age 64 years, about half with Type II diabetes), a Greek pattern of food intake including onions/leeks, olive oil, garlic, and feta cheese, was inversely associated with diabetic retinopathy, hypertriglyceridemia, and hyperhomocysteinemia.33 An animal study found that 8 weeks of a high-fat, high-canola oil diet + feta cheese resulted in higher HDL and lower total cholesterol, LDL, and triglycerides compared to 8 weeks of a high-fat, high-canola oil + butter diet.34

Fiber(Trigonella foenum-graecum)

119

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Fiber Definition Nondigestible, structural material in plant foods that is generally categorized into soluble and insoluble types, each varying in water solubility, fermentability, and viscosity, characteristics responsible for unique physiological effects and food characteristics.35 Soluble and insoluble fibers often occur together in foods. Particularly rich sources of soluble fiber include citrus fruits, apple pulp, apple pectin, infant banana flakes, green bananas, legumes, oat bran, oatmeal, barley, beans, okra, peas, rice bran, and strawberries.36–38 Soluble, or viscous, fibers, such as guar gum, pectin, psyllium, and certain hemicelluloses, retain water and form a viscous gel in the gastrointestinal tract. This thereby delays gastric emptying, slowing the transit of food through the upper gastrointestinal tract, slowing the absorption of nutrients from the small intestine, and entrapping bile salts and cholesterol in the large intestine; in addition, soluble fiber holds moisture in stools, softening them.39,40 Rich sources of insoluble fibers include whole wheat breads, wheat cereals, wheat bran, rye, rice, barley, most other grains, cabbage, beets, carrots, Brussels sprouts, turnips, cauliflower, and apple skin.35 Insoluble fibers, such as hemicellulose and cellulose, serve as bulk that increases fecal weight and promotes stool passage through the colon.36 The food group that is highest in fiber as a group is legumes (8 g per ½ cup serving) followed by vegetables (3 g per ½ cup), nuts and seeds (3 g per 1 oz), fruits (2 g per ½ cup), and whole grain products (1 to 2 g per 1 slice or ½ cup). The usual dietary fiber intake in the United States is 15 g per day41 and should be increased by expanding variety in daily food patterns to include more and different types of plant foods.

Scientific Findings Foods high in dietary fiber are generally low in calories. Dietary fiber intake from whole foods may lower blood pressure, improve serum lipids, and reduce indicators of inflammation.42 Insoluble fibers help to prevent and alleviate constipation; reduce the risk of diverticulosis, hemorrhoids, and appendicitis; and promote satiety which may aid in weight

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Fiber

management.37 Soluble fibers help to alleviate diarrhea; reduce fasting plasma cholesterol which is associated with reduced risk of heart disease; and reduce postprandial glucose, which is associated with reduced risk of diabetes.37,43 Soluble fibers may modestly reduce LDL cholesterol levels beyond that achieved by a diet low in saturated fat and trans fats alone.35

Bioactive Dose The Dietary Reference Intakes recommend 14 g of dietary fiber per 1,000 kcalories, an AI of 25 g/day for women and 38 g/day for men. The National Cholesterol Education Program Expert Panel recommends consuming 10–25 g of soluble fiber per day in addition to a diet low in saturated fat to reduce LDL cholesterol;44 5–10 g of soluble fiber per day reduces LDL cholesterol levels by approximately 5%.45 Diets supplying 30–50 g of fiber per day from whole food sources consistently produce lower serum glucose levels compared to a low fiber diet.46

Safety No UL for fiber has been established. Increasing dietary fiber too quickly can lead to gas, bloating, and cramps. Due to the bulky nature of fibers, excess consumption is likely to be self-limiting.49 Fiber binds to minerals and increases their excretion; therefore, excessive fiber intake may have adverse effects upon mineral absorption, hence, the World Health Organization recommends an upper limit of 40 g/day.37

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Fig (Ficus carica)

F

Definition Small, 2–3-inch purple fruit with thin skin and edible seeds. It is mild in flavor and a good source of fiber (1.4 g, 10% DV per fig).48 Phytochemical components include phenolics, coumarins, flavonoids (e.g., anthocyanins, quercetin, luteolin), and terpenoids.49 Consumed fresh, dried, as jam, and made into fruit filling for baked products. It has a history of use as a laxative, for diabetes, hyperlipidemia, eczema, psoriasis, and vitiligo,26 although there is no evidence to evaluate its effect on these conditions.

Scientific Findings Figs demonstrated antioxidant properties50 and suppressed various types of cancer cells in vitro.51

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals. Fig has been associated with allergic reaction.26

Flavonoids Definition Class of hundreds of structurally unique phytochemicals that are relatively common in the average American diet, and which “are usually

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subdivided according to their substituents into: anthocyanidins, catechins, chalcones, flavones, flavonols, flavanones, and isoflavones.”52,53 “Flavonoids provide the bright orange, yellow, and red pigments of various foods, along with characteristic flavors, such as the hearty taste of whole wheat foods or the bitter taste of red grapes.”54 Flavonoids are found in citrus fruits and citrus-based juices, other fruits, vegetables, grains, nuts, seeds, spices, flowers, tea, red wine, and products made from soy and cocoa beans.52,54,55 Flavonoids are transported in serum by albumin, thus, theoretically, protein malnutrition may reduce serum circulating levels of flavonoids.56 Plants containing flavonoids have a long history of use in traditional medicines in many cultures, but flavonoids themselves were not discovered until the 1930s.57 Certain plants and spices containing flavonoids have been used for thousands of years in traditional Eastern medicine.49 Flavonoids are the most widely distributed plant polyphenol and account for approximately two-thirds of plant polyphenols in the human diet. It has been estimated that the average daily US intake of flavonoids is between 20 mg and 1 g.58

Scientific Findings “Flavonols, flavanones, and flavones are subclasses of flavonoids that exert cardioprotective and anticarcinogenic properties in vitro and in vivo.”26 Dietary flavonoid intake was associated with a decreased risk of advanced stage prostate cancer in the Netherlands Cohort study (n = 58,279 men).59 Flavonoids have demonstrated anti-inflammatory properties in experimental models of rheumatoid arthritis (RA), but a review of human data found little evidence to support flavonoids’ anti-inflammatory effects in RA.60 A meta-analysis based on findings of the 20-year Zutphen Elderly Study showed “a nearly statistically significant 43% reduced risk of all cancers associated with high vs. low consumption of flavonoids and a halving in risk for gastrointestinal and respiratory cancers.”61 “The activity of flavonoids as inhibitors of reverse transcriptase suggests a place for these compounds in the control of retrovirus infections, such as [AIDS].”62

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Flaxseed (Linum usitatissimum)

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Flaxseed (Linum usitatissimum)

F Definition Tiny brown or gold seeds that come from the flax plant whose genus and species name Linum usitatissimum derives from “most useful” due to the utility of the plant for food, linen, and linseed oil.63 Flaxseeds have a mild, nutty flavor and may be consumed ground or whole.64 Flaxseed are 35–45% fiber, making them an excellent source of fiber of which ⅔ is insoluble and ⅓ is soluble.65 Flaxseeds contain potassium (341 mg, 7% DV per ¼ cup)66 are a good source of iron (2.4 mg of iron, 13% DV), in addition to being a rich source of linolenic acid and beta-sitosterol.67 Flaxseeds, flaxseed cereals and breads, and flaxseed oil may require refrigeration to prevent rancidity and also should not be heated to high temperatures to prevent off-odor and flavor development. Hippocrates wrote about flaxseed being a laxative.65

Scientific Findings Flaxseed contains soluble fiber that is an effective laxative and decreases blood total cholesterol by increasing bile acids in the feces, thereby lowering blood cholesterol. While most research shows that taking flaxseed 30–50 g per day reduces total cholesterol by 5–15% and LDL cholesterol by 8–18%, a meta-analysis of 28 studies found flaxseed oil was not more effective in reducing total cholesterol or LDL cholesterol compared to olive, rapeseed, hempseed, safflower, or sunflower oil.68 Flaxseed oil suppresses oxygen radical production by white blood cells, prolongs bleeding time, and in higher doses suppresses serum levels of inflammatory mediators, but is not an effective hypolipemic agent.69

Bioactive Dose Not known.

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Folate

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals. A safety review of flaxseed found: severe allergic reactions to flaxseed and flaxseed oil have been reported; that flaxseed or flaxseed oil taken by mouth may cause mania or hypomania in people with bipolar disorder; that people with diarrhea, irritable bowel syndrome, diverticulitis, or inflammatory bowel disease (Crohn’s Disease or ulcerative colitis) should avoid flaxseed due to its possible laxative effects; that large amounts of flaxseed by mouth can cause ileus; that people with narrowing of the esophagus or intestine, ileus, or bowel obstruction should avoid flaxseed; based upon animal studies, an overdose of flaxseed may cause shortness of breath, rapid breathing, weakness, difficulty walking, and seizures or paralysis; that flaxseed may stimulate menstruation and that animal studies have shown possible harmful effects during pregnancy; therefore, the use of flaxseed or flaxseed oil during pregnancy and breastfeeding is not recommended.70 Raw or unripe flaxseeds, which may contain potentially toxic compounds, should be avoided.65

Folate Definition Also called folic acid. Water-soluble vitamin involved in the manufacture of deoxyribonucleic acid necessary for cell division and tissue growth. Folate requires vitamin B12 to be converted to a form necessary to manufacture deoxyribonucleic acid.71 Synthetic folic acid is more bioavailable than naturally occurring folate. The quantity of this vitamin in the diet, though measured in µg, may be expressed in Dietary Folate Equivalents to encompass the absorption difference between the synthetic form, found in commercial grain products and dietary supplements (folic acid), and the natural form found foods (folate). Approximately 8% of Americans have inadequate intakes of folate-based on Estimated Average Requirements.72 Acceptable range for serum folate is 3–16 mg/mL and an acceptable range for erythrocyte folate is 140–628 ng/mL of packed cells.73 Folate deficiency impairs cell division and protein synthesis, two of the first symptoms of which are megaloblastic anemia and GI tract deterioration.73 Deficiency of folate (and other B vitamins including vitamins B6 and B12) is associated with hyperhomocysteinemia (homocysteine > 12–15 μmol/L) (note: there is debate about the definition of hyperhomocysteinemia, with the starting point of “high” homocysteine beginning at 9 μmol/L and ranging up to 20 μmol/L74). Hyperhomocysteinemia is “an independent predictor for all-cause mortality and it compromises health of all organ systems.”75, 76

Fructan(Linum usitatissimum)

125

Scientific Findings Hyperhomocysteinemia is a risk factor for atherothrombotic and neuropsychiatric disorders.77 To reduce the risk of in utero neural tube defect development of infants, women of reproductive age should consume 400 µg of folate/folic acid daily beginning before pregnancy, and 600 µg of folate/ folic acid throughout gestation.78 Folate deficiency impairs cell division and protein synthesis and can cause megaloblastic anemia. Several, but not all, epidemiologic studies provide evidence of an inverse relationship between folate intake and the risk of pancreatic cancer.79 Some, but not all studies, support an association between folate intake and colon cancer development.80–82 A diet rich in folate was associated with a statistically significant lower risk of cerebral infarction, but not intracerebral or subarachnoid hemorrhage, in a large observational trial (n = 26,556 Finnish male smokers, aged 50–69).83 Low serum folate has been found in patients with recurrent mood disorders treated with lithium and in patients with alcoholism who have depression, and is linked to poor response to antidepressants.84

Bioactive Dose The RDA of folic acid for men and non-pregnant women age 19–50 is 400 µg; for pregnant women: 600 µg; and for lactating women: 500 µg.

Safety The UL for folic acid is 1,000 µg. Exceeding the UL for folic acid might pose a health risk for individuals with vitamin B12 deficiency (see also: Vitamin B12) for whom a surplus of folic acid can delay the diagnosis of a vitamin B12 deficiency.

Fructan Definition Also called fructooligosaccharide (FOS). Naturally occurring polymer of fructose, an example of which is inulin. Found in asparagus, Jerusalem artichokes, chicory, bananas, garlic, and onion.85–88

Scientific Findings Fructans are natural sweeteners that have a low caloric value, do not lead to a rise in serum glucose, do not stimulate insulin secretion, promote the growth of intestinal bifidobacteria, and may improve the absorption of certain minerals.88,89 Fructans and other fermentable carbohydrates can cause gas and worsen gastrointestinal (GI) symptoms that occur in

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Fruit

irritable bowel syndrome.90 A review of 34 studies including experimental and human clinical trials concluded that FOS may have a beneficial effect on lipid metabolism and regulation of serum cholesterol levels when combined with lifestyle and dietary changes.91

Bioactive Dose For hypertriglyceridemia, the typical dose of inulin is 10–14 g daily; for hypercholesterolemia, 6 g three times daily has been used for up to 6 weeks.92

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals. Fructans and other indigestible carbohydrates are fermented in the lower GI tract and cause gas. People prone to gastrointestinal distress due to IBS, celiac disease, and those following a low FODMAP (fructooligosaccharides, oligosaccharides, disaccharides, and polyols) diet should avoid fructans.90

Fruit Definition An under-consumed food group that is a good source of vitamins A and C, folate, potassium, and fiber, in addition to different phytochemicals that vary by color, where generally blue/purple plant foods contain anthocyanidins, flavonols, flavan-3-ols, proanthocyanidins, ellagic acid, and resveratrol; green plant foods typically contain flavones, flavanones, flavonols, beta-carotene, lutein, xeaxathin, indoles, isothiocyanates, and organosulfur compounds; white plant foods contain typically contain flavonols, flavanones, indoles, isothiocyanates, and organosulfur compounds; yellow plant foods typically contain flavonols, flavanones, alpha-carotene, betacarotene, beta-cryptoxanthin, and xeaxanthin; and red plant foods typically contain anthocyanins, flavonols, flavones, flavan-3-ols, flavanones, proanthocyanidins, lycopene, ellagic acid, and resveratrol.93

Scientific Findings People who consume diets rich in plant foods, including fruits, have a lower risk of getting cancers of the mouth, pharynx, larynx, esophagus, stomach, and lung; some evidence suggests that maintaining a diet rich in plant foods also lowers the risk of cancers of the colon, pancreas, and prostate. As well, this diet reduces the risk of diabetes, heart disease, and hypertension; helps to reduce calorie intake; and may help to control

References

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weight.94 Consuming a diet containing high amounts of plant foods, including fruits, is associated with fewer age-related diseases such as Alzheimer’s Disease.95

Bioactive Dose One to two cups of fruit is recommended for most people for general health,96 whereas 0.9 daily cup equivalents of fruit per 1,000 calories is recommended to help prevent the cancers cited in Scientific Findings.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals. Many fruit allergies have been reported.

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75. Shils ME, Olson JA, Shike M, Ross AC. Modern Nutrition in Health and Disease. 9th edn. Baltimore, MD: Williams & Wilkins; 1999. 76. Shiao PK, Lie A, Yu CH. Meta-analysis of homocysteine-related factors on the risk of colorectal cancer. Oncotarget. 2018;9(39): 25681–25697. 77. Watanabe F, Yabuta Y, Tanioka Y, Bito T. Biologically active vitamin B12 compounds in foods for preventing deficiency among vegetarians and elderly subjects. J Agric Food Chem. 2013 Jul 17;61(28):6769–6775. 78. March of Dimes. Statement on Folate Status of Women. www.m​archo​fdime​ s.com​/abou​t us/7​91_18​69.as​p. Accessed September 2, 2010. 79. Sanchez GV, Weinstein SJ, Stolzenberg-Solomon RZ. Is dietary fat, vitamin D, or folate associated with pancreatic cancer? Mol Carcinogen. 2012;51(1):119–127. 80. Duties SJ, Mayrommatis Y, Rucklidge G, Reid M, Duncan G, Moyer MP, Pirie LP, Bestwick CS. The response of human colonocytes to folate deficiency in vitro: functional and proteomic analyses. J Proteome Res. 2008;7(8):3254–3266. 81. Kim J, Kim DH, Lee BH, Kang SH, Lee HJ, Lim SY, Suh YK, Ahn YO. Folate intake and the risk of colorectal cancer in a Korean population. Eur J Clin Nutr. 2009;63(9):1057–1064. 82. Eussen SJ, Vollset SE, Igland J, Meyer K, Fredriksen A, Ueland PM, Jenab M, Slimani N, Boffetta P, Overvad K, Tjønneland A, Olsen A, Clavel-Chapelon F, Boutron-Ruault MC, Morois S, Weikert C, Pischon T, Linseisen J, Kaaks R, Trichopoulou A, Zilis D, Katsoulis M, Palli D, Berrino F, Vineis P, Tumino R, Panico S, Peeters PH, Bueno-de-Mesquita HB, van Duijnhoven FJ, Gram IT, Skeie G, Lund E, González CA, Martínez C, Dorronsoro M, Ardanáz E, Navarro C, Rodríguez L, Van Guelpen B, Palmqvist R, Manjer J, Ericson U, Bingham S, Khaw KT, Norat T, Riboli E. Plasma folate, related genetic variants, and colorectal cancer risk in EPIC. Cancer Epidemiol Biomarkers Prev. 2010;19(5):1328–1340. 83. Larsson SC, Mannisto S, Virtanen MJ, Kontto J, Albanes D, Virtamo J. Folate, vitamin B6, vitamin B12, and methionine intakes and risk of stroke subtypes in male smokers. Am J Epidemiol. 2008;167(8):954–961. 84. Coppen A, Bolander-Gouaille C. Treatment of depression: time to consider folic acid and vitamin B12. J Psychopharmacol. 2005 Jan;19(1):59–65. 85. Ramnani P, Gaudier E, Bingham M, van Bruggen P, Tuohy KM, Gibson GR. Prebiotic effect of fruit and vegetable shots containing Jerusalem artichoke inulin: a human intervention study. Br J Nutr. 2010;104(2):233–240. 86. Chandrashekar PM, Venkatesh YP. Fructans from aged garlic extract produce a delayed immunoadjuvant response to ovalbumin antigen in BALB/c mice. Immunopharmacol Immunotoxicol. 2012;34(1):163–169. 87. Roberfroid MB. Introducing inulin-type fructans. Br J Nutr. 2005;93(Suppl 1):S13–S25. 88. Sabater-Molina M, Larqué E, Torrella F, Zamora S. Dietary fructooligosaccharides and potential benefits on health. J Physiol Biochem. 2009;65(3):315–328. 89. Niness KR. Inulin and oligofructose: what are they? J Nutr. 1999;129(7 Suppl):1402S–1406S. 90. Whelan K, Martin LD, Staudacher HM, Lomer MCE. The low FODMAP diet in the management of irritable bowel syndrome: an evidence-based review of FODMAP restriction, reintroduction and personalisation in clinical practice. J Hum Nutr Diet. 2018;31(2):239–255.

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91. Costa GT, Abreu GC, Guimarães AB, Vasconcelos PR, Guimarães SB. Fructooligosaccharide effects on serum cholesterol levels. An overview. Acta Cir Bras. 2015;30(5):366–370. 92. Jellin JM, Gregory PJ, et al. Natural Medicines Comprehensive Database. Therapeutic Research Faculty. 2013. https://naturaldatabase.com/. Accessed July 11, 2012. 93. Produce for Better Health. Fruit and Veggies More Matters Phytochemical List. www.p​bhfou​ndati​on.or​g/abo​ut/re​s/pic​/phyt​olist​/. Accessed July 21, 2013. 94. National Cancer Institute. Cancer Progress Trends Report. http:​//pro​gress​ repor​t.can​cer.g​ov/pr​event​ion/f​ruit_​veget​able. Accessed February 6, 2015. 95. Joseph JA, Shukitt-Hale B, Willis LM. Grape juice, berries, and walnuts affect brain aging and behavior. J. Nutr. 2009 Sept;139(9):1813S–1817S. 96. ChooseMyPlate.gov. How much fruit is needed daily? www.c​hoose​mypla​ te.go​v/foo​d-gro​ups/f​ruits​-amou​nt.pd​f. Accessed February 6, 2015.

F

G Garbanzo bean (Cicer arietinum) Definition Legume also known as chickpea. A good source of fiber (3 g, 11% DV per ½ cup), garbanzo beans also contain numerous phytochemicals, including flavonoid glycosides.1,2 Hummus is a purée of garbanzo beans, lemon, cumin, garlic, and tahini.

Scientific Findings Garbanzo beans have a low glycemic index3 and may be used as a lowfat substitute for meat. One oz of meat, poultry, or fish is nutritionally equivalent to ¼ cup cooked of garbanzo beans, although the iron content and absorption is lower in garbanzo beans, as is the case for all legumes, compared to meat. See also: flavonoids (Table G.1).

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Table G.1  Iron Comparison in Legumes vs. Meat ChooseMyPlate.gov Protein Food Group Standard Quantities

Iron, mg

% DV

Iron Bioavailability (Approximate Amount of Iron Absorbed)68

Garbanzo beans, ¼ cup Sirloin steak, 1 oz

0.7269 1.470

4% 8%

2–20% 23%

135

G

G

136

Garlic (Allium sativum)

Garlic (Allium sativum) Definition Edible lily family bulb that is a common culinary ingredient. It produces allyl sulfur compounds such as allicin, methyl allyl trisulfide, and diallyl trisulfide, when cut or crushed, which each may have unique health properties. Other phytochemical constituents include flavonoids and terpenoids. Garlic is among the oldest of all cultivated plants and has been used for culinary and medicinal purposes for thousands of years.4 Allicin is partly responsible for the flavor and odor of cut garlic.5 Allicin was previously considered to be a key bioactive constituent of garlic, but was found to be highly unstable and freshly crushed garlic may contain only limited amounts of to no allicin.5 Garlic’s biological activity is likely due to several components of garlic, which may include organosulfur transformation products of allicin.

Scientific Findings Though preliminary research demonstrated a relationship between garlic consumption and a slight reduction in blood cholesterol level, and that garlic may slow the progression of atherosclerosis,6 fresh garlic, dried powdered garlic tablets, and aged garlic extract tablets all were found to be ineffective at lowering serum cholesterol in a controlled trial6 and a meta-analysis representative of available evidence on the effects of garlic on serum cholesterol from RCTs found no beneficial effect of garlic on serum cholesterol.7 The same meta-analyses found the methyl allyl trisulfide component of garlic may be antithrombotic.6 Nevertheless, a dose of fresh garlic 4 g (approximately one clove) once daily has been used to treat hyperlipidemia;10 for hypertension, the dose of garlic powder 600–900 mg daily has been used.10 If garlic consumption does reduce the risk of developing cancer, the amount needed to lower risk remains unknown.14 Garlic may reduce cardiac arrhythmias.8 Some evidence has suggested that garlic consumption may slightly reduce blood pressure, particularly in people with high blood pressure;6 other evidence does not support an appreciable effect of garlic in reducing blood pressure in people with high blood pressure.9 Taking low doses of garlic powder orally, 300 mg per day, lessened age-related decreases in aortic elasticity, while higher doses of 900 mg per day seemed to slow development of atherosclerosis in both aortic and femoral arteries when used over a 4-year period.10 Laboratory studies demonstrated that garlic, and or some of its allyl sulfur compounds, suppress carcinogen formation and bioactivation and tumor proliferation.11 Diallyl trisulfide exhibited chemoprotective properties experimentally.12 However, a review of the effects of garlic consumption and various cancers found “no credible evidence to support a relation between garlic intake

Ginger (Zingiber officinale)

137

and a reduced risk of gastric, breast, lung, or endometrial cancer,” and very limited evidence of a relationship between garlic consumption and a reduced risk of colon, prostate, esophageal, larynx, oral, ovary, or renal cell cancers.13 According to the National Cancer Institute, “Preliminary studies suggest that garlic consumption may reduce the risk of developing several types of cancer, especially cancers of the gastrointestinal tract. Most of the studies evaluated different types of garlic preparations and used them in varying amounts.”14 Garlic’s antifungal properties have been demonstrated in laboratory research.15,16 In laboratory studies, aged garlic extract, but not fresh garlic extract, exhibited antioxidative activity.17 Aged garlic extract exhibited hepatoprotective and neuroprotective properties.18 In laboratory studies, allicin and compounds into which it transforms when processed, exhibited antimicrobial properties,19 and treatment with allicin arrested human mammary cancer cells in a laboratory study.20

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals. Side effects may include breath and body odor, heartburn, upset stomach, and allergic reactions. Garlic is an anticoagulant and intake should be considered in patients with bleeding disorders or who are on anticoagulants and during or after surgery (garlic use should be stopped 7–10 days in advance of surgery, or if dental work is planned).21

Ginger (Zingiber officinale) Definition Rhizome, or underground stem similar to a root, commonly used in Asian cooking, such as in pickled slivers as a sushi condiment. It is also used as a dry spice powder and to flavor ginger ale, and consumers should look for “made with real ginger.” Ginger contains niacin and phytochemicals including phytosterols, berberine, and the pungent compound zingerone.22–24 Ginger has been used in traditional Asian medicine to alleviate stomachache, nausea, and diarrhea.25

Scientific Findings Ginger promotes saliva production and gastric juice secretion, and produces an increase in the tone and peristalsis of the intestine.26 In an animal study, zingerone inhibited colonic motility via direct action on smooth

G

G

138

Glucosinolates

muscles.27 Berberine exhibited anti-inflammatory effects in vivo and in vitro. A systematic review of six RCTs (n = 439 subjects) evaluating the efficacy of ginger for nausea and vomiting found a non-significant difference between ginger and placebo.28 Another review of 27 RCTs (n = 4,041 subjects) examining various interventions for nausea, vomiting, and retching in early pregnancy found that the “use of ginger products may be helpful to women, but the evidence of effectiveness was limited and not consistent.”29 Ginger may help to reduce nausea due to cancer chemotherapy when used in addition to conventional anti-nausea medication.

Bioactive Dose The antiemetic dose is 2 g of ginger powder taken with liquid.29 An infusion is made from pouring boiling water over 0.5–1 g ginger (1 teaspoon = 3 g ginger) and straining after 5 minutes.29

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals. The Physician’s Desk Reference for Herbal Medicines contraindicates the use of ginger during pregnancy for morning sickness related to reports that ingesting ginger during pregnancy might affect fetal sex hormones and a separate case report of spontaneous abortion during week 12 of pregnancy in a patient who used ginger for morning sickness.29 However, NIH recommends consulting with a physician regarding the use of ginger during pregnancy and states that ginger may be used short-term to safely relieve the nausea of pregnancy without harm to the fetus.28 Ginger should not be taken by individuals suffering from gallstones, except after consultation with a medical professional, because it increases bile production.28

Glucosinolates Definition Secondary plant metabolites found in Brassica plants that transform into various active compounds including sulforaphane and indole-3-carbinol.

Scientific Findings Epidemiological and in vivo evidence suggests sulforaphane indole-3-carbinol exert anticancer properties.30,31 When Brassica foods are prepared by boiling, blanching, or fermenting, glucosinolate content is significantly reduced, whereas preparing by steaming, microwaving, or stir-frying either retains or only slightly reduces the glucosinolate content.32 Sprouts

Glycosides

139

of Brassica vegetables typically contain significantly higher concentrations of glucosinolates than mature plants.33

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals. Glucosinolates impair thyroid uptake of iodine.34

Glutathione Definition Compound that is synthesized in the body and is a component of the antioxidant enzyme glutathione peroxidase. Fresh fruits, vegetables, and meats have moderate to high amounts of glutathione.35 The spice cumin is also a source of glutathione.36

Scientific Findings Glutathione is thought to prevent free radical formation in humans.37

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Glycosides Definition Sugar derivatives produced biochemically in plants, such as garbanzo beans, blackberries,1,38 and Stevia rebaudiana, used to make the natural sweetener Stevia.39

Scientific Findings Glycosides were shown to be antioxidants, suppress cancer cell growth, and exert antiatherogenic properties in laboratory studies.42

G

G

140

Grains

Bioactive Dose Not known.

Safety Presumed to be safe when consumed in normal dietary quantities by nonallergic individuals, except amygdalin, found in non-consumable portions of fruits (for example, the inedible pits of peaches), which is a wellknown toxic cyanogenic glycoside.

Grains Definition Seed-like fruits found at the stem tops of various plants but particularly those plants belonging to the Poaceae (grass) family. Cereals, the edible grain produced by plants within the grass family, consist of the outer husk called the bran, which encloses the center endosperm and inner germ. The outer bran consists mostly of fibers but also contains phytates. The endosperm consists mostly of starch and the inner germ contains high concentrations of fats, proteins, and vitamins such as vitamin E. When the bran and germ are removed during processing (refining) to increase shelf life and palatability, many nutrients are also removed including fiber, fat, protein, vitamins, and phytochemicals. “Enriched” refined grains (containing the word “enriched” in their ingredient listing), are processed grain foods to which thiamin, riboflavin, niacin, folic acid, and iron have been added.

Scientific Findings A case-control study (n = 384 pancreatic adenoma cases and 983 matched controls) found an increased association between pancreatic adenocarcinoma and intake of non-whole grains, and an inverse association between pancreatic adenocarcinoma and intake of whole grains.40 A meta-analysis of 48 articles comprising 16 cohorts identified high intakes of refined grains, along with other processed foods, as significantly associated with diabetes risk.41

Bioactive Dose Not applicable.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Grains, Whole

141

Grains, Whole Definition Grains with the bran, germ, and endosperm intact. Whole grains provide fiber and a wide variety of naturally occurring nutrients, depending upon the specific grain, but generally include B vitamins, vitamin E, selenium, zinc, copper, and magnesium, along with phytochemicals such as phenolic compounds,42 antioxidants, and phytoestrogens. Examples include oats, popcorn, brown rice, and products whose first ingredient in the ingredient listing is the word “whole.” For example, “Ingredients: Whole wheat.”

Scientific Findings Epidemiological studies have shown that whole grain intake is protective against cancer, cardiovascular disease, diabetes, and obesity.43 Cancer: A meta-analysis of 11 cohort studies (n = 1,719,590 participants between 25 and 76 years of age) found consumption of whole grains was inversely associated with the risk of developing colorectal cancer.44 A meta-analysis of 25 prospective observational studies (n=>14,500 cases) found that a high intake of dietary fiber, in particular, cereal fiber and whole grains, was associated with a reduced risk of colorectal cancer.45 Possible mechanisms of action for a protective effect of dietary fiber and whole grain consumption and risk of colorectal cancer include diluting fecal carcinogens, decreasing transit time, the production of short-chain fatty acids by the fermentation of fiber, and/or some action of individual constituents, such as antioxidants, vitamins, trace minerals, phytate, phenolic acids, lignans, phytoestrogens, folate, and magnesium.46,49 In a case-control study (n = 384 pancreatic adenoma cases and 983 matched controls) epidemiologic surveys and food frequency questionnaires showed that highest quintiles of whole grain intake were inversely associated with having pancreatic adenocarcinoma (for which several mechanisms associated with whole grains or fiber were postulated: decreased insulin resistance, decreased triglyceride levels, and/or elevated high-density lipoprotein levels).42 Cardiovascular Disease: A meta-analysis of nine randomized clinical trials (n = 1,414 healthy subjects, mean age 45–59) examining whole grain diets for a minimum of 12 weeks compared to lower whole grain or refined grain diets found “insufficient evidence … of an effect of whole grain diets on cardiovascular outcomes or on major CVD risk factors such as blood lipids and blood pressure.” Diabetes: A meta-analysis of 1 RCT and 11 prospective cohort studies found evidence “too weak to be able to draw a definite conclusion about the preventative effect of whole grain foods on the development of Type II diabetes.”46 Obesity: Weight-loss diets rich in whole grains, fruits, and vegetables, or both for 10 weeks improved weight and blood pressure in a randomized clinical trial of overweight

G

G

142

Grape (Vitis vinifera)

and obese women (n = 75), but HDL was most improved within the whole grain compared to the fruit and vegetable or combination whole grainfruit/vegetable group.47

Bioactive Dose Three servings of whole grains per day and “making half your grains whole” are general USDA recommendations for healthy people. One “serving” varies with each food (e.g., one serving of oatmeal is ½ cup while one serving of a whole wheat bread is a 1-oz slice).

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Grape (Vitis vinifera) Definition Marble-sized snack fruit that contains numerous phytochemicals, depending on variety, such as catechin, epicatechin, resveratrol, flavonoid proanthocyanidins, quercetin, and kaempferol.48 Eaten fresh and made into other products such as juice, jam or jelly, raisins, and wine. Grape leaves are consumed in Middle Eastern cuisine and are an excellent source of vitamin K.49 Concord grape (Vitis labrusca) juice is high in vitamin C and polyphenols.

Scientific Findings Purple grape juice (200 ml combined with 30 ml of blackcurrant flavor cordial) dosed on two separate occasions acutely enhanced aspects of cognition and mood in a placebo-controlled double-blind RCT (n = 20 healthy young adults).50 A dosage of 10 ml/kg of purple grape juice did not improve memory or mood in smokers (n = 36).51 A 12-week, placebocontrolled, double-blind RCT (n = 12 adults with early memory decline but not dementia) that dosed Concord grape juice at 6–9 mL/kg daily significantly improved a measure of verbal learning and resulted in a nonsignificant enhancement of verbal and spatial recall; however, fasting insulin was increased for those consuming grape juice.52

Bioactive Dose Not known.

Grapefruit (Citrus paradisi)

143

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals. Grape seed extracts have been safely used for up to 8 weeks in clinical studies.54

Grapefruit (Citrus paradisi) Definition Large yellow- or pink-fleshed citrus fruit that is an excellent source of vitamin C and a source of folate and potassium, whether its juice or the whole fruit is consumed.53 Naringin is a bitter principle of grapefruit and flavonoid that is partly responsible for grapefruit juice enhancing the bioavailability of certain medications.54

Scientific Findings A red grapefruit variety (Citrus paradise Macf.) exhibited antioxidant properties in a laboratory study.55 Eating 1.5 grapefruits daily for six weeks did not significantly reduce markers of inflammation and oxidative stress in a small, controlled clinical trial of overweight/obese subjects (n = 69), though grapefruit consumption produced a favorable modulation of oxidative stress in overweight and obese adults with metabolic syndrome.56 Grapefruit juice produced a greater decrease in mean arterial blood pressure when compared with orange juice in an experimental study.57 In laboratory studies, naringin exhibited antioxidant properties, inhibited tumor growth, and suppressed age-related blood pressure increases in hypertensive rats.58–60

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals. Grapefruit juice has been found to increase the absorption of certain drugs, including simvastatin and lovastatin,24 and to increase cortisol availability in patients with Addison’s Disease;61 therefore, people on these medications may be advised to avoid grapefruit juice.

G

G

144

Green Leaf(y) Vegetables

Green Leaf(y) Vegetables Definition Versatile family of plant foods, such as basil, arugula, and spinach, known for their antioxidant capacity. In particular, Brassica vegetables are sources of specific phytochemicals, such as flavonoids and glucosinolates. Generally, dark green leafy vegetables are noted for providing vitamin E, folate, magnesium, vitamin K, and chlorophyll. Tender leafy green vegetables are common salad vegetables; heartier leafy green vegetables may be cooked or can be thinly minced and consumed fresh. Herb-like leafy green vegetables, such as basil and arugula, are used for their pungent flavors as seasonings, but can be made into main dishes, such as pesto.

Scientific Findings Consumption of green leafy vegetables is associated with a reduced risk of several types of cancer and cardiovascular disease.62 A high intake of green leafy vegetables was associated with a reduced risk of non-Hodgkin’s Lymphoma in a population-based case-control study (n = 348 cases and 470 controls) in which a higher intake of green leafy vegetables and cruciferous vegetables was associated with a lower risk of non-Hodgkin’s Lymphoma.63 In a case-control study (n = 384 pancreatic adenoma cases and 983 matched controls) where dark green vegetable consumption was determined by epidemiologic survey and food frequency questionnaire, evidence was observed to support that higher vegetable consumption, including dark green vegetables and other plant foods, was significantly inversely associated with pancreatic adenocarcinoma.40

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Guava (Psidium guajava)

145

Guava (Psidium guajava)

G Definition Lime-sized fruit whose tough skin may be yellow, red, or purple and whose flesh may be yellow, pink, or red, depending on variety.64 Guavas are tropical fruits with edible seeds that are sources of polyphenols and are good sources of fiber (3 g, 10% DV) and vitamin A (343 IU, 11% DV), and excellent sources of vitamin C (125 mg, 138% DV) per 1 fruit.65,66 Guavas are consumed fresh or as juice.

Scientific Findings 300 mL of guava juice added to the diet of anemic children (n = 95 children aged 6–9) for 10 weeks marginally increased hemoglobin and plasma ferritin.66 The 200 mg of vitamin C per 300 mL serving of guava juice was attributed with increasing the absorption of nonmeat-flesh iron, such as vegetable sources of iron. Preliminary research suggests guava lectin and galactose may have antidiarrheal properties.67

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

G

146

References

References

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G

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38. Kaume L, Howard LR, Devareddy L. The blackberry fruit, its composition and chemistry, metabolism and bioavailability, and health benefits. J Agric Food Chem. 2011 Nov 14;60(23):5716–5727. 39. Yadav SK, Guleria P. Steviol glycosides from Stevia: biosynthesis pathway review and their application in foods and medicine. Crit Rev Food Sci Nutr. 2012;52(11):988–998. 40. Jansen RJ, Robinson DP, Stolzenberg-Solomon RZ, Bamlet WR, de Andrade M, Oberg AL, Hammer TJ, Rabe KG, Anderson KE, Olson JE, Sinha R, Petersen GM. Fruit and vegetable consumption is inversely associated with having pancreatic cancer. Cancer Causes Control. 2011;22(12):1613–1625. 41. Jannasch F, Kröger J, Schulze MB. Dietary patterns and Type 2 diabetes: a systematic literature review and meta-analysis of prospective studies. J Nutr. 2017 Jun;147(6):1174–1182. 42. Slavin JL, Jacobs D, Marquart L, Wiemer K. The role of whole grains in disease prevention. J Am Diet Assoc. 2001;101(7):780–785. 43. Slavin J. Why whole grains are protective: biological mechanisms. Proc Nutr Soc. 2003;62(1):129–134. 44. Haas P, Machado MJ, Anton AA, Silva AS, de Francisco A. Effectiveness of whole grain consumption in the prevention of colorectal cancer: meta-analysis of cohort studies. Int J Food Sci Nutr. 2009;60(Suppl 6):1–13. 45. Aune D, Chan DS, Lau R, Vieira R, Greenwood DC, Kampman E, Norat T. Dietary fibre, whole grains, and risk of colorectal cancer: systematic review and dose-response meta-analysis of prospective studies. BMJ. 2011;343:d6617. 46. Priebe MG, van Binsbergen JJ, de Vos R, Vonk RJ. Whole grain foods for the prevention of Type 2 diabetes mellitus. Cochrane Database Syst Rev. 2008 Jan 23;(1): CD006061. 47. Fatahi S, Daneshzad E, Kord-Varkaneh H, Bellissimo N, Brett NR, Azadbakht L. Impact of diets rich in whole grains and fruits and vegetables on cardiovascular risk factors in overweight and obese women: a randomized clinical feeding trial. J Am Coll Nutr. 2018 Apr 27:1–10. 48. US Department of Agriculture. Agricultural Research Service. Phytochemical Database. Grapes. www.p​l.bar​c.usd​a.gov​/usda​_plan​t/pla​nt _ho​me.cf​m. Accessed November 24, 2011. 49. US Department of Agriculture. Agricultural Research Service. Nutrient Database. Grape leaves. http:​//ndb​.nal.​usda.​gov/n​db/fo​ods/s​how/3​565? f​g=&ma​n=&lf​acet=​&form​at=&c​ount=​&max=​25&of​fset=​&sort​=&qlo​okup=​ grape​s. Accessed June 16, 2013. 50. Haskell-Ramsay CF, Stuart RC, Okello EJ, Watson AW. Cognitive and mood improvements following acute supplementation with purple grape juice in healthy young adults. Eur J Nutr. 2017 Dec;56(8):2621–2631. 51. Hendrickson SJ, Mattes RD. No acute effects of grape juice on appetite, implicit memory and mood. Food Nutr Res. 2008;52(1):1891. 52. Krikorian R, Nash TA, Shidler MD, Shukitt-Hale B, Joseph JA. Concord grape juice supplementation improves memory function in older adults with mild cognitive impairment. Br J Nutr. 2010 Mar;103(5):730–734. 53. US Department of Agriculture. Agricultural Research Service. Nutrient Data Laboratory. Grapefruit, white, raw. http:​//ndb​.nal.​usda.​gov/n​db/fo​ods /s​how/2​244?f​g=&ma​n=&lf​acet=​&form​at=&c​ount=​&max=​25&of​fset=​&sort​ =&qlo​okup=​grape​fruit​. Accessed August 9, 2013.

References

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54. De Castro WV, Mertens-Talcott S, Rubner A, Butterweck V, Derendorf H. Variation of flavonoids and furanocoumarins in grapefruit juices: a potential source of variability in grapefruit juice-drug interaction studies. J Agric Food Chem. 2006;54(1):249–255. 55. Jayaprakasha GK, Girennavar B, Patil BS. Radical scavenging activities of Rio Red grapefruits and sour orange fruit extracts in different in vitro model systems. Bioresour Technol. 2008;99(10):4484–4494. 56. Dow CA, Wertheim BC, Patil BS, Thomson CA. Daily consumption of grapefruit for 6 weeks reduces urine F2-isoprostanes in overweight adults with high baseline values but has no effect on plasma high-sensitivity C-reactive protein or soluble vascular cellular adhesion molecule 1. J Nutr. 2013 Jul 31;143(10):1586–1592. 57. Díaz-Juárez JA1, Tenorio-López FA, Zarco-Olvera G, Valle-Mondragón LD, Torres-Narváez JC, Pastelín-Hernández G. Effect of Citrus paradisi extract and juice on arterial pressure both in vitro and in vivo. Phytother Res. 2009 Jul;23(7):948–954. 58. Jagetia GC, Reddy TK. Alleviation of iron-induced oxidative stress by the grapefruit flavanone naringin in vitro. Chem Biol Interact. 2011 Feb 20;190(2–3):121–128. 59. Ikemura M, Sasaki Y, Giddings JC, Yamamoto J. Preventive effects of hesperidin, glucosyl hesperidin and naringin on hypertension and cerebral thrombosis in stroke-prone spontaneously hypertensive rats. Phytother Res. 2012 Jan 7;26(9):1272–1277. 60. Camargo CA, Gomes-Marcondes MC, Wutzki NC, Aoyama H. Naringin inhibits tumor growth and reduces interleukin-6 and tumor necrosis factor α levels in rats with walker 256 carcinosarcoma. Anticancer Res. 2012;32(1):129–133. 61. Methlie P, Husebye EE, Hustad S, Lien EA, Løvås K. Grapefruit juice and licorice increase cortisol availability in patients with Addison's disease. Eur J Endocrinol. 2011;165(5):761–769. 62. Jin J, Koroleva OA, Gibson T, Swanston J, Magan J, Zhang Y, Rowland IR, Wagstaff C. Analysis of phytochemical composition and chemoprotective capacity of rocket (Eruca sativa and Diplotaxis tenuifolia) leafy salad following cultivation in different environments. J Agric Food Chem. 2009;57(12):5227–5234. 63. Chiu BC, Kwon S, Evens AM, Surawicz T, Smith SM, Weisenburger DD. Dietary intake of fruit and vegetables and risk of non-Hodgkin lymphoma. Cancer Causes Control. 2011;22(8):1183–1195. 64. Produce for Better Health. Guava. www.f​ruits​andve​ggies​morem​atter​s.org​/ guav​a Accessed June 16, 2013. 65. United States Department of Agriculture. Agricultural Research Service. National Nutrient Database for Standard Reference Legacy Release. Guava. https​://nd​b.nal​.usda​.gov/​ndb/f​oods/​show/​09139​?fgcd​=&man​u=&fo​rmat=​ &coun​t=&ma​x=25&​offse​t=&so​r t=de​fault​&orde​r=asc​&qloo​k up=g​u ava&​ ds=&q​t=&qp​=&qa=​&qn=&​q=&in​g=. Accessed July 16, 2018. 66. Monárrez-Espino J, López-Alarcón M, Greiner T. Randomized placebo-controlled trial of guava juice as a source of ascorbic acid to reduce iron deficiency in Tarahumara indigenous schoolchildren of northern Mexico. J Am Coll Nutr. 2011;30(3):191–200.

G

G

150

References

67. Coutiño-Rodríguez R, Hernández-Cruz P, Giles-Ríos H. Lectins in fruits having gastrointestinal activity: their participation in the hemagglutinating property of Escherichia coli O157: H7. Arch Med Res. 2001;32(4):251–257. 68. DeBruyne LK, Pinna K. Nutrition for Health and Health Care. 6th edn. Boston, MA: Cengage; 2017. 69. US Department of Agriculture. Agricultural Research Service. National Nutrient Database for Standard Reference Legacy Release. Garbanzo beans. https​://nd​b.nal​.usda​.gov/​ndb/f​oods/​show/​45020​185?m​a n=&l​facet​=&cou​ nt=&m​a x=25​&qloo​k up=g​a rban​z o+be​a ns&o​f fset​=&sor​t=def​ault&​forma​ t=Ful​l&rep​ortfm​t=oth​er&rp​tfrm=​&ndbn​o=&nu​trien​t1=&n​utrie​nt2=&​nutri​ ent3=​&subs​et=&t​otCou​nt=&m​easur​eby=&​Q3529​55=0.​25&Qv​=1&Q3​52955​ =0.5&​Qv=1.​Accessed January 3, 2018. 70. US Department of Agriculture. Agricultural Research Service. National Nutrient Database for Standard Reference Legacy Release. Sirloin steak. https​://nd​b.nal​.usda​.gov/​n db/f​o ods/​s how/​13931​?fgcd​= &man​u =&fo​ rmat=​&coun​t =&ma​x=25&​offse​t =&so​r t=de​f ault​&orde​r =asc​&qloo​k up=s​ irloi ​n+ste​a k&ds​=&qt=​&qp=&​qa=&q​n=&q=​& ing=​. Accessed January 3, 2018.

H Hazelnut (Corylus avellana)

H

Definition Marble-sized nut, also called a filbert, that is a good source of protein, monounsaturated fatty acid, tocopherols, and phytosterols.1 Hazelnuts, cocoa, sugar, and, palm oil are used to make the popular chocolate spread Nutella®. Dry-roasted hazelnuts are added to nut mixes and sweetened dry-roasted hazelnuts are used as crunchy yogurt toppings.

Scientific Findings In a laboratory study, hazelnuts’ phenolic compounds exerted antioxidant effects.2 In a 4-week single intervention study (n = 21 normolipemic, healthy individuals), a hazelnut-enriched diet (1 g/kg/day) decreased the atherogenic tendency of LDL by reducing oxidized LDL levels and increasing vitamin E in LDL.3

151

H

152

Honey

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals. Hazelnut allergy has been reported.

Hemicellulose Definition Type of dietary fiber that has characteristics of both insoluble and soluble fibers. It surrounds cellulose in plant cell walls.4,5 Legumes, fruits, and vegetables (particularly younger or less mature vegetables), and grains are the main sources of hemicellulose in the diet.6

Scientific Findings Fibers in the large intestine promote stool passage and are associated with lower rates of diverticular disease, hemorrhoids, and appendicitis.4

Bioactive Dose Not known. The DRI for fiber (of all types) is 25–38 g daily for women and men aged 19–50 years, respectively.

Safety The World Health Organization recommends a dietary fiber upper limit of 40 g per day.4 Fiber intake exceeding 40 g has been associated with decreased absorption of minerals.

Honey Definition Intensely sweet viscous simple sugar, made of glucose and fructose, that is produced by bees from flower nectar. Flavors of honey vary depending upon the flower source. Use has been documented in the world’s oldest medical literature for its topical healing properties due to its “high viscosity that helps to provide a protective barrier to infection.”7,8

Honeydew melon (Cucumis melo L. var. inodorus Naud)

153

Scientific Findings Honey contains the antibacterial protein royalisin.7 Four different varieties of honey exerted antimicrobial effects against S. Aureus in a laboratory study.9 Clinical research from several RCTs shows that taking honey 2.5–10 mL (0.5–2 teaspoons) at bedtime can significantly reduce nighttime cough frequency and severity compared to placebo in children with upper respiratory infections.10 Honey also appears to be at least as effective or more effective than the cough suppressant dextromethorphan in typical over-the-counter doses and the antihistamine diphenhydramine.12

Bioactive Dose For cough, 2.5–10 mL (0.5–2 teaspoons) of honey.12

Safety Fetal and infant exposure should be avoided because honey could contain potentially harmful pyrrolizidine alkaloids (honey sourced from pyrrolizidine alkaloid-containing plants represents a significant source of honey worldwide).11 Regarding botulism, honey consumption is safe in children over one year of age.13

Honeydew melon (Cucumis melo L. var. inodorus Naud)12 Definition Considered to be the sweetest commercially available melon and one of the ten most consumed melons in the US, the honeydew melon has pale green, juicy flesh, and its ripeness is reflected by its creamy yellow, inedible rind. One-half cup of honeydew contains potassium (202 mg, 4% DV) and folate (17 µg, 4% DV), and is a good source of vitamin C (15.5 mg, 11% DV).13 Cucurbitacin-β is among its phytochemical constituents.17

Scientific Findings Cucurbitacin-β has exhibited anti-hepatotoxic, anti-inflammatory, and anticancer properties in laboratory studies.17

Bioactive Dose Not known.

H

154

Hops (Humulus lupulus L.)

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Hops (Humulus lupulus L.)

H

Definition

1. Flower of the hop plant; contains phytoestrogens and chalcones. 2. The major bitter flavoring in beer; also used as a food preservative. 3. Traditional uses of hops include as a sleep aid, stomachic, antibacterial, and antifungal agent7, 14

Scientific Findings Sedative effects of hops have been observed in laboratory animals.16 In vivo and in vitro studies have demonstrated stomachic, antibacterial, antifungal, and cancer-preventative properties of hops.16

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Horseradish (Armoracia rusticana, Cochlearia armoracia)

155

Horseradish (Armoracia rusticana, Cochlearia armoracia)

H Definition Thick, woody root vegetable belonging to the Brassicaceae family that is a source of potassium and phytochemicals such as lutein, xeaxanthin, and glucosinolates.15–17 It is ground and processed into prepared horseradish that is mixed with other ingredients, such as vinegar, and used as a condiment. Its major flavoring constituent, allyl isothiocyanate, causes a burning sensation when it comes in contact with the mouth. Green-colored horseradish is frequently substituted for wasabi, the sushi condiment, in the US. Horseradish has been used to cure scurvy due to it vitamin C content (3.7 mg, 4% DV per 1 tablespoon).18

Scientific Findings Horseradish exhibited antibacterial properties in an in vitro study.19 In a placebo-controlled clinical trial, horseradish also helped prevent urinary tract infections.19 The German Commission E has approved horseradish for oral use as “supportive therapy for infections of the urinary tract.”20

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals. It has a strong and irritating odor and contact with the mouth causes a burning sensation.

H

156

References

References 1. Maguire LS, O’Sullivan SM, Galvin K, O’Connor TP, O’Brien NM. Fatty acid profile, tocopherol, squalene and phytosterol content of walnuts, almonds, peanuts, hazelnuts and the macadamia nut. Int J Food Sci Nutr. 2004;55(3):171–178. 2. Shahidi F, Alasalvar C, Liyana-Pathirana CM. Antioxidant phytochemicals in hazelnut kernel (Corylus avellana L.) and hazelnut byproducts. J Agric Food Chem. 2007;55(4):1212–1220. 3. Yücesan FB, Orem A, Kural BV, Orem C, Turan I. Hazelnut consumption decreases the susceptibility of LDL to oxidation, plasma oxidized LDL level and increases the ratio of large/small LDL in normolipidemic healthy subjects. Anadolu Kardiyol Derg. 2010;10(1):28–35. 4. Whitney E, DeBruyne LK, Pinna K, Rolfes SR. Nutrition for Health and Health Care. 4th edn. Belmont, CA: Cengage Learning; 2011. 5. Institute of Medicine. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Washington, DC: National Academy Press; 2002. 6. Dhingra D, Michael M, Rajput H, Patil RT. Dietary fibre in foods: a review. J Food Sci Technol. 2012;49(3):255–266. 7. Der Marderosian A, Beutler J. The Review of Natural Products. 5th edn. St. Louis, MO: Wolters Kluwer; 2008. 8. Mandala MD, Mandal S. Honey: its medicinal property and antibacterial activity. Asian Pac J Trop Biomed. 2011;1(2):154–160. 9. Boukraâ L, Niar A, Benbarek H, Benhanifia M. Additive action of royal jelly and honey against Staphylococcus aureus. J Med Food. 2008;11(1):190–192. 10. Jellin JM, Worthington M. Natural Medicines. Therapeutic Research Faculty. 2018. https​://na​t ural​medic​ines.​thera​peuti​crese​arch.​com/. Accessed June 17, 2018. 11. Edgar JA, Roeder E, Molyneux RJ. Honey from plants containing pyrrolizidine alkaloids: a potential threat to health. J Agric Food Chem. 2002;50(10):2719–2730. 12. Lester G. Melon (Cucumis melo L.) fruit nutritional quality and health functionality. Hort Technol. 1997;7(3):222–227. 13. US Department of Agriculture. Agricultural Research Service. National Nutrient Database. Melon, honeydew, raw. www.n​ al.us​ da.go​ v/fni​ c/foo​ dcomp​/cgi-​bin/l​ist_n​ut_ed​it.pl​. Accessed April 12, 2011. 14. Zanoli P, Zavatti M. Pharmacognostic and pharmacological profile of Humulus lupulus L. J Ethnopharmacol. 2008;116(3):383–396. 15. US Department of Agriculture. Agricultural Research Service. National Nutrient Database. Horseradish, prepared. http:​//ndb​.nal.​usda.​gov/n​db/fo​ ods/s​how/2​74. Accessed January 11, 2012. 16. US Department of Agriculture. Agricultural Research Service. Phytochemical Database. Cochlearia armoracia. www.p​l.bar​c.usd​a.gov​/usda​ _plan​t/pla​nt_de​tail.​cfm?c​ode=6​96855​64&pl​ant_i​d=100​&y1s2​7=&Th​isNam​e =ps7​21. Accessed January 10, 2012. 17. Mucete D, Borozan A, Radu R, Jianu I. Antibacterial activity of isothiocyanates, active principles in Armoracia rusticana. J Agroaliment Processes Technol. 2006;12(2):443–452.

References

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18. Wedelsbäck Bladh K, Olsson KM. Introduction and use of horseradish (Armoracia rusticana) as food and medicine from antiquity to the present: emphasis on the Nordic countries. J Herbs, Spices Med Plants. 2011;17(3):197–213. 19. Albrecht U, Goos KH, Schneider B. A randomised, double-blind, placebocontrolled trial of a herbal medicinal product containing Tropaeoli majoris herba (Nasturtium) and Armoraciae rusticanae radix (Horseradish) for the prophylactic treatment of patients with chronically recurrent lower urinary tract infections. Curr Med Res Opin. 2007;23(10):2415–2422. 20. Gruenwald J, ed. The PDR for Herbal Medicines. 1st edn. Montvale, NJ: Medical Economics; 1998.

H

I Inulin Definition Fermentable carbohydrate (classified as a fructooligosaccharide or fructan) found in plant foods, such as asparagus, bananas, chicory, dandelion, garlic, Globe artichoke, Jerusalem artichoke, leeks, onions, wheat bran, and wheat flour, that is a prebiotic.1] The average American eats 2.6 g of insulin daily.2 Fermentable carbohydrates may produce gas, bloating, pain, and other undesirable GI symptoms.

Scientific Findings Inulin improves laxation by increasing stool bulk, water content, and certain fecal bacteria, and may strengthen the intestinal epithelium possibly reducing the risk of gastrointestinal diseases.3,4 Inulin dosed at 15 g daily improved stool frequency in constipated elderly individuals (n = 25) in a 28-day randomized, double-blind, controlled clinical trial (n = 252).5 Gut microbiota improved in inulin-supplemented (0.8 g/dL) formula-fed newborn infants compared to breastfed infants in a double-blind, randomized, placebo-controlled clinical trial lasting for four months.6 See also: Fructan.

Bioactive Dose For treatment of constipation in the elderly, 20–40 g daily for 19 days has been used.7

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals. People with inflammatory bowel disease (Crohn’s Disease, ulcerative colitis), irritable bowel syndrome, and an estimated 20% of people with celiac disease, could minimize GI distress by avoiding fermentable carbohydrates.8

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I

I

160

Iodine

Iodine Definition Trace mineral that functions as part of the thyroid hormones triiodothyronine (T3) and thyroxine (T4) that regulate basal metabolism, growth, and body temperature.9 Chinese medical literature dating to approximately 3600 BC “were the first to record the decreases in goiter size upon ingestion of seaweed and burnt sea sponge.”10 It has been estimated that ⅓ of the world’s population consumes insufficient iodine11 and more than one billion people worldwide are iodine deficient.12 In the US, however, average daily adult intake of iodine has been estimated to be between 210 (140% DV) and 300 µg (200% DV),7 amounts that exceed the Recommended Dietary Allowance and the 150-µg Reference Dietary Intake (used to display % DV). Foods sourced from the ocean, including seafood and seaweed, are good sources of iodine, and sea salt contains some natural iodine; other good sources of iodine are vegetables and fruits grown in coastal, iodinerich soil. Milk is a source of iodine due to the use of iodophor disinfectants used by the dairy industry (a practice that some commercial dairies have voluntarily discontinued), as well as iodine-containing feed additives given to dairy cows. 13,14 Declaration of iodine content and iodine % DV are not required on Nutrition Facts labels. Additional sources of incidental iodine include iodine-containing dough conditioners used in the bakery industry12,15 and iodine additives used in processed foods such as calcium iodate, potassium iodate, cuprous iodide, and the type of additive used to fortify salt: potassium iodide. The iodization of salt was initiated in 1924 to eradicate goiter in response to high rates of goiter in inland “goiter belt” (Great Lakes, Appalachians, and Northwest) regions of US.8 Iodine is also absorbed transcutaneously from exposure to car exhaust that creates iodine vapor from the combustion of organic fuels and topical exposure to iodine preparations, such as iodine antiseptics.11 Multivitamin-mineral supplements may commonly supply 100% DV for iodine, negating the need for additional iodine intake (Table I.1).

Scientific Findings Both iodine deficiency and iodine excess in otherwise healthy individuals can compromise thyroid function.11 Thyroid enlargement is the earliest clinical feature of iodine deficiency, but excess iodine can also produce goiter.7 Epidemiological studies have shown that an increased incidence of autoimmune thyroid disease frequently parallels an increased dietary iodine intake,16 underscoring the need for adequate, but not excessive, iodine intake. Determination of individual iodine intake is difficult in part because nutrition databases typically do not include iodine. Recent data that are representative of the general US population showed that

Iodine

161

median urinary iodine concentration (UIC) in 2009–2010 was 144 μg/L, a level considered to be associated with adequate intake of iodine; however, pregnant women in their first and second trimesters had inadequate UIC.17 UIC is generally not useful to classify intake sufficiency or deficiency in a person and is more useful to identify groups at risk of iodine deficiency according to experts;16 however, other experts believe UIC to be useful: “Roughly 90% of all iodine consumed is excreted in the urine and thus, [UIC] is a sensitive indicator for current intake. UIC can be easily measured in a relatively inexpensive manner through the collection of a spot-urine sample. The World Health Organization (WHO) defines the following median UIC (mUIC) concentrations of nutritional iodine sufficiency for a population: excessive iodine intake, ≥ 300 µg/L; more than adequate intake, 200–299 µg/L; adequate intake, 100–199 µg/L; mild iodine deficiency, 50–99 µg/L; moderate iodine deficiency, 20–49 µg/L; and severe iodine deficiency.”18 Table I.1  Iodine Content of Common Foods 2% milk, 240 ml Nonfat milk, 240 ml Organic 2% milk, 240 ml

Infant formula, 150 ml Cod, cooked, 3 oz (85 g) Shrimp, cooked 3 oz (85 g) Corn grits, enriched, cooked, ½ cup Bread, 1 (~ 50 g) slice Whole wheat bread, 2 slices (50 g) Oatmeal, cooked 1 cup Cornflakes, 3 ½ c (100 g) Flour Tortilla, 1 (55 g) Navy beans, ½ cup (~ 90 g) Baked potato, 1 small (110 g) Turkey breast, cooked, 3 oz (85 g) Salami, (100 g) Cottage cheese, 2% (½ cup) Egg, cooked, 1 large (50 g) Iodized salt, 1 teaspoon45 (1 g)46 One A Day® Women’s Multivitamin-Mineral Centrum Silver Multivitamin-Mineral Sources: 7, 10, 12–16

63 μg 51 μg Varies by brand, but this information was not available at several manufacturers who were contacted 6.2–56.8 μg 99 μg 35 μg 68 μg 23–300 μg 32 μg 16 μg 93 μg 41 μg 35 μg 34 μg 34 μg 28 μg 26–71 μg 24 μg 45 μg15 150 µg47 150 µg48

I

I

162

Iron

Insufficient maternal iodine intake during pregnancy causes maternal and neonatal hypothyroidism and increases the risk of neurological damage and cretinism, a form of preventable mental retardation and deafness, in the baby.7 Iodine prevented the increase of testosterone-induced oxidative stress in a model of rat prostatic hyperplasia by exhibiting antiproliferative and antioxidant effects.19

Bioactive Dose The adult RDA for iodine is 150 μg. The pregnancy RDA is 220 μg.

Safety The UL for iodine for adults aged 19–50 years is 1,100 µg. Excessive intake of iodine from food, beverages, and supplements has been associated with adverse effects such as thyroiditis, goiter, hypothyroidism, and hyperthyroidism.7

Iron Definition Trace mineral found in hemoglobin in red blood cells and myoglobin in muscle cells that supplies oxygen necessary for energy metabolism. Heme iron occurs bound to hemoglobin or myoglobin in animal flesh and sources include meat, poultry, fish, and seafood, but not non-flesh animal foods, such as eggs. Nonheme iron is found in eggs, legumes, beans, peas, processed soy products, and iron-fortified enriched cereals. Heme iron is well-absorbed (approximately 23%) compared to nonheme iron (2–20%), but vitamin C and meat, poultry, and seafood improve nonheme iron absorption 20,24 Hemoglobin concentrations lower than 11–12 g/dL in children younger than 12, 12 g/dL in adolescents and women, and 13 g/dL in men indicate iron deficiency anemia.23

Scientific Findings Insufficient iron intake during pregnancy increases infant risk of low birthweight, premature birth, low iron stores, and impaired cognitive and behavioral development, as well as increases the mother’s risk for developing iron deficiency anemia.21 Iron deficiency anemia affects approximately 10% of Americans and is especially common in toddlers, children, adolescents, and reproductive-aged women.21 Symptoms of iron deficiency and iron deficiency anemia include: fatigue upon

Isoflavones

163

physical exertion, poor exercise tolerance, impaired energy metabolism, decreased mental productivity, decreased academic aptitude, decreased neurotransmitter synthesis, irritability, apathy, and restlessness. Iron deficiency is associated with poor diet, malabsorptive disorders, and blood loss, people with iron deficiency usually have other nutrient deficiencies concomitantly.24

Bioactive Dose The RDA for adults aged 19–50 is 18 mg for women of reproductive age and 8 mg for men. Since it is unlikely that the amount of iron required during pregnancy will be met by diet alone, iron-replete pregnant women require a daily dietary supplement of iron.22 The pregnancy RDA for iron is 27 mg. Iron-deficient pregnant women will require > 27 mg of iron daily to correct their deficiency.

Safety The UL for adults aged 19 and older is 45 mg. Excess iron may be a major cause of iron-induced oxidative stress.24

Isoflavones Definition Flavonoid phytoestrogens23 whose chemical structure is similar to estrogen24 that act as selective estrogen receptor modulators25 (exerting both estrogenic and non-estrogenic properties) depending on the amount and type consumed and endogenous hormonal status of the organism. They are much less potent than endogenous estrogen.26 Daidzein, genistein, and glycitein are three major types of isoflavones found in certain fruits, vegetables, breads and cereals, meats, nuts, seeds, legumes, tofu, tempeh, soybeans, and soybean products.27 US intake of isoflavones has been estimated to be 1.13 mg/d,28 whereas typical Japanese intake is 30–50 mg/ day.29 One serving of a traditional soyfood, such as 100 g of tofu or 250 mL soymilk, typically provides about 25 mg isoflavones.27

Scientific Findings A meta-analysis showed no cholesterol-lowering effect of soy isoflavones (n = 208 hypercholesterolemic adults)30 and a second meta-analysis found that ingestion of an average of 70 mg of soy isoflavones/day for 1–3 months did not significantly change total cholesterol or LDL cholesterol compared with a placebo in normocholesterolemic menopausal women (n = 565).30 A

I

I

164

Isoprenoids

metabolite of the daidzein, equol, was found, in 14 studies, to significantly improve cholesterol and other lipids, inflammation, and other variables.31 Soy foods’ skeletal effect seems to be dependent upon its content of isoflavones.32 A meta-analysis of 43 RCTs (n = 4,364 participants) found no conclusive evidence that phytoestrogen supplements effectively reduce the frequency or severity of hot flushes and night sweats in perimenopausal or postmenopausal women, but noted that four trials not combined in the meta-analysis showed high (>30 mg/day) levels of genistein consistently reduced the frequency of hot flushes and that “benefits derived from concentrates of genistein should be further investigated.”33 A meta-analysis that included 47 RCTs (n = 8,326 menopausal women) found that isoflavones were more effective than placebo at relieving vasomotor symptoms, but not significantly better than transdermal estradiol and progestogen, which were effective treatments.34 See also: Soybean and Phytoestrogens.

Bioactive Dose Though doses of isoflavones used to reduce blood lipids in studies have ranged from 40–318 mg/day,7 the dose needed to achieve significant decreases in total or LDL cholesterol or triglycerides has not been established.35 Quantities of 50–100 mg/day have been shown to have positive effects on markers of bone mineral density (BMD) in epidemiology and human clinical trials.33,34

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals. Isoflavones exert goitrogenic effects.36

Isoprenoids Definition Phytochemicals such as menthol from peppermint oil, citral from lemongrass oil, and limonene from citrus rinds that impart flavors and fragrances. Fruits, vegetables, and cereal grains contain a variety of isoprenoid compounds.37

Scientific Findings Isoprenoids possess anticancer activity in laboratory research.38

Bioactive Dose Not known.

References

165

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Isothiocyanates Definition Phytochemicals formed from the breakdown of glucosinolates39 that are found in mustard seed and Brassica vegetables, such as watercress and broccoli sprouts.40

Scientific Findings Isothiocyanates are antimicrobial against a wide spectrum of pathogens and exhibited anticancer activity in cell cultures and animal models.41–44 A review of epidemiological studies that examined associations between phytochemicals and cancer risk found mostly null associations between individual phytochemicals and cancer risk at various sites. In those studies showing an effect, it found consistent protective effects for higher dietary intake, serum, plasma, or urinary metabolites of isothiocyanates and lung cancer and gastrointestinal cancer.47

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals. Isothiocyanates are known to be genotoxic, and therefore, pose a potential risk at high levels of intake, the specific level of which is not known.46

References

1. Davidson MH, Maki KC. Nutritional and health benefits of inulin and oligofructose. J Nutr. 1999;129:1474S–1477S. 2. Moshfegh AJ, Friday JE, Goldman JP, Ahuja JKC. Presence of inulin and oligofructose in the diets of Americans. J Nutr. 1999:129(7):1407S–1411S. 3. Cherbut C. Inulin and oligofructose in the dietary fibre concept. Br J Nutr. 2002;87: S159–S162. 4. Roberfroid M. Dietary fiber, inulin, and oligofructose: a review comparing their physiological effects. Crit Rev Food Sci Nutr. 1993;33(2):103–148.

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5. Marteau P, Jacobs H, Cazaubiel M, Signoret C, Prevel JM, Housez B. Effects of chicory inulin in constipated elderly people: a double-blind controlled trial. Int J Food Sci Nutr. 2011 Mar;62(2):164–170. 6. Closa-Monasterolo R, Gispert-Llaurado M, Luque V, Ferre N, Rubio-Torrents C, Zaragoza-Jordana M, Escribano J. Safety and efficacy of inulin and oligofructose supplementation in infant formula: results from a randomized clinical trial. Clin Nutr. 2013;32(6):918–927. 7. Jellin JM, Gregory PJ, et al. Natural Medicines Comprehensive Database. Therapeutic Research Faculty. 2013. https://naturaldatabase.com/. Accessed July 11, 2012. 8. Meltzer Warren R. A Teen’s Guide to Gut Health. New York: Workman Publishing The Experiment; 2017. 9. Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press; 2001. 10. Leung AM, Braverman LE, Pearce EN. History of US iodine fortification and supplementation. Nutrients 2012;4:1740–1746. 11. Román GC. Nutritional disorders in tropical neurology. Handb Clin Neurol. 2013;114:381–404. 12. Santos JE, Freitas M, Fonseca CP, Castilho P, Carreira IM, Rombeau JL, Branco M. Iodine deficiency a persisting problem: assessment of iodine nutrition and evaluation of thyroid nodular pathology in Portugal. J Endocrinol Invest. 2017 Feb;40(2):185–191. 13. Kraft D and Der Marderosian A. The A-Z Guide to Food As Medicine 1st ed; Boca Raton, FL: CRC Press; 2016. 14. Pearce EN, Pino, S, He, X, Bazrafshan HR, Lee, SL, Braverman, LE. Sources of dietary iodine: bread, cow’s milk, and infant formula in the Boston area. J Clin Endocrinol Metabol. 2004 July 1;89(7):3421–3424. 15. Pennington JAT. Bowe’s & Church’s Food Values of Portions Commonly Used. 17th edn. Philadelphia, PA: Lippincott Williams & Wilkins; 1998. 16. Dunn JT. Editorial: what’s happening to our iodine? J Clin Endocrinol Metab. 1998;83(10):3398–3400. 17. Caldwell KL, Pan Y, Mortensen ME, Makhmudov A, Merrill L, Moye J. Iodine status in pregnant women in the National Children's Study and in US women (15–44 years), National Health and Nutrition Examination Survey 2005–2010. Thyroid. 2013 Aug;23(8):927–937. 18. Herrick KA, Perrine CG, Aoki Y, Caldwell KL. Iodine status and consumption of key iodine sources in the US population with special attention to reproductive age women. Nutrients. 2018;10:874. 19. Quintero-García M, Delgado-González E, Sánchez-Tusie A, Vázquez M1, Aceves C, Anguiano B. Iodine prevents the increase of testosterone-induced oxidative stress in a model of rat prostatic hyperplasia. Free Radic Biol Med. 2018 Feb 1;115:298–308. 20. Whitney E, DeBruyne LK, Pinna K, Rolfes SR. Nutrition for Health and Health Care. 4th edn. Belmont, CA: Cengage Learning; 2011. 21. National Institutes of Health Office of Dietary Supplements. Iron fact sheet. http:​//ods​.od.n​ih.go​v/fac​tshee​ts/Ir​on-He​althP​rofes​siona​l/. Accessed April 15, 2015.

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22. Procter SB, Campbell CG. Position of the Academy of Nutrition and Dietetics: nutrition and lifestyle for a healthy pregnancy outcome. J Acad Nutr Diet. 2014;114:1099–1103. 23. Tillem J, Hardy M. Soy foods and breast cancer risk reduction. Altern Med Alert. 1999;2:109–113. 24. Kim SH, Kim CW, Jeon SY, Go RE, Hwang KA, Choi KC. Chemopreventive and chemotherapeutic effects of genistein, a soy isoflavone, upon cancer development and progression in preclinical animal models. Lab Anim Res. 2014;30(4):143–150. 25. Messina M. Soy and health update: evaluation of the clinical and epidemiologic literature. Nutrients. 2016 Nov 24;8(12). pii: E754. 26. US Department of Health and Human Services Food and Drug Administration 21 CFR Part 101 [Docket No. 98P–0683] Food Labeling: Health Claims; Soy protein and Coronary Heart Disease Federal Register. October 26, 1999; 64(206):5770. 27. US Department of Agriculture. Agricultural Research Service. 2008. USDA Database for the Isoflavone Content of Selected Foods, Release 2.0. Nutrient Data Laboratory home page: www.ars.usda.gov/nutrientdata/isoflav. 28. Chun OK, Chung SJ, Song WO. Estimated dietary flavonoid intake and major food sources of US adults. J Nutr. 2007;137:1244–1252. 29. Messina M, Ho S, Alekel DL. Skeletal benefits of soy isoflavones: a review of the clinical trial and epidemiologic data. Curr Opin Clin Nutr Metab Care. 2004;7(6):649–658. 30. Taku K, Umegaki K, Ishimi Y, Watanabe S. Effects of extracted soy isoflavones alone on blood total and LDL cholesterol: meta-analysis of randomized controlled trials. Ther Clin Risk Manage. 2008;4(5):1097–1103. 31. Birru RL, Ahuja V, Vishnu A, Evans RW, Miyamoto Y, Miura K, Usui T, Sekikawa A. The impact of equol-producing status in modifying the effect of soya isoflavones on risk factors for CHD: a systematic review of randomised controlled trials. J Nutr Sci. 2016;19(5):e30. 32. Academy of Nutrition and Dietetics. Evidence Analysis Library.. Is there a dose–response relationship of the soy protein and/or isoflavone effects on cholesterol levels? http:​//and​evide​nceli​brary​.com/​concl​usion​.cfm?​concl​ usion​_ stat​ement​_id=9​5. Accessed July 29, 2013. 33. Lethaby A, Marjoribanks J, Kronenberg F, Roberts H, Eden J, Brown J. Phytoestrogens for menopausal vasomotor symptoms. Cochrane Database Syst Rev. 2013 Dec 10;(12):CD001395. 34. Sarri G, Pedder H, Dias S, Guo Y, Lumsden MA. Vasomotor symptoms resulting from natural menopause: a systematic review and network metaanalysis of treatment effects from the National Institute for Health and Care Excellence guideline on menopause. BJOG. 2017;124(10):1514–1523. 35. Academy of Nutrition and Dietetics Evidence Analysis Library. Is there a dose-response relationship of the soy protein and/or isoflavone effects on cholesterol levels? www.a​ndeal​.org/​topic​.cfm?​cat=1​060&e​viden​ce_su​m mary​_id=9​6&hig​hligh​t=iso​flavo​nes&h​ome=1​. Accessed June 25, 2018. 36. Doerge DR, Sheehan DM. Goitrogenic and estrogenic activity of soy isoflavones. Environ Health Perspect. 2002 Jun;110(Suppl 3):349–353. 37. Craig WJ. Phytochemicals: guardians of our health. J Am Diet Assoc. 1997;97(10): S199–S204.

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38. Burke YD, Stark J, Roach SL, Sen SE, Crowell PL. Inhibition of pancreatic cancer growth by the dietary isoprenoids farnesol and geraniol. Lipids. 1997;32(2):151–156. 39. Shapiro TA, Fahey JW, Wade KL, Stephenson KK, Talalay P. Human metabolism and excretion of cancer chemoprotective glucosinolates and isothiocyanates of cruciferous vegetables. Cancer Epidemiol Biomarkers Prev. 1998;7:1091–1100. 40. Bhattacharya A, Li Y, Wade KL, Paonessa JD, Fahey JW, Zhang Y. Allyl isothiocyanate-rich mustard seed powder inhibits bladder cancer growth and muscle invasion. Carcinogenesis. 2010;31(12):2105–2110. 41. Lin CM, Preston JF, Wei CI. Antibacterial mechanism of allyl isothiocyanate. J Food Prot. 2000;63(6):727–734. 42. Fimognari C, Turrini E, Ferruzzi L, Lenzi M, Hrelia P. Natural isothiocyanates: genotoxic potential versus chemoprevention. Mutat Res. 2011 Dec 10;750(2):107–131. 43. Miller PE, Snyder DC. Phytochemicals and cancer risk: a review of the epidemiological evidence. Nutr Clin Pract. 2012 Oct;27(5):599–612. 44. Zhang Y. Allyl isothiocyanate as a cancer chemopreventive phytochemical. Mol Nutr Food Res. 2010;54(1):127–135. 45. US Department of Agriculture. Agricultural Research Service. USDA Branded Food Products Database. Iodized salt. https​://nd​b.nal​.usda​.gov/​ ndb/f​o ods/​show/​33127​8?man​=&lfa​cet=&​count​=&max​=&qlo​okup=​&offs​ et=&s​ort=&​forma​t =Ful​l&rep​ortfm​t =oth​e r&rp​t frm=​& ndbn​o =&nu​t rien​ t1=&n​utrie​nt2=&​nutri​e nt3=​& subs​e t=&t​otCou​nt=&m​e asur​e by=&​Q3698​ 99=0.​165&Q​v=1&Q​36989​9=0.1​7&Qv=​1. Accessed June 18, 2018. 46. Torburg L. Mayo Clinic News Network. Mayo Clinic Q and A: Sea salt and sufficient iodine intake. https​://ne​wsnet​work.​mayoc​linic​.org/​discu​ssion​/ mayo​-clin​ic-q-​and-a​-sea-​salt-​and-s​uffic​ient-​iodin​e-int​ake/. Accessed June 18, 2018. 47. One a Day women’s supplement facts pdf. www.oneaday.com/womens. Accessed January 3, 2018. 48. What’s inside centrum? Iodine. www.centrum.com/whats-inside/ingredients. Accessed January 3, 2018.

J Jasmine Rice (Oryza sativa L.)

J

Definition Long- or medium-grain rice variety noted for being aromatic and characteristically flowery when cooked due to the chemical 2-acetyl-1-pyrrolin.1,2 Grown primarily in Thailand, 1 cup of white enriched jasmine rice is a good source of thiamin (0.31 mg, 25% DV), niacin (3.4 mg, 21% DV), iron (2.77 mg, 15% DV), and folic acid (180 µg, 45% DV), and supplies riboflavin (0.03 mg, 2% DV)3; and 1 cup of brown jasmine rice is an excellent source of iron (4.3 mg, 23% DV) and fiber (7.9 g, 28% DV).4 Rice is one of the longest cultivated cereal grains believed to have been grown for at least 5,000 years.5 It is a primary staple food and significant contributor of calories in the Japanese daily diet.6

Scientific Findings Both white and brown rice are high glycemic index foods;7 people with diabetes may benefit from lower-glycemic-index foods, such as rice noodles.8 A questionnaire survey of 1,848 men and women between 20 and 60 years of age found that rice, possibly due to its high glycemic index, was 169

170

Jerusalem Artichoke (Helianthus tuberosus)

associated with better sleep quality, while bread and noodles were associated with poor sleep quality.6

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Jerusalem Artichoke (Helianthus tuberosus)

J

Definition Edible root, also called a sun root or sunchoke, that is a species of sunflower. It is neither from Jerusalem nor an artichoke. Rather, it is a tuber that is cooked. Similar to water chestnuts in taste, Jerusalem artichoke carbohydrate is primarily inulin, an indigestible carbohydrate that is fermented in the colon, versus starch that is digested and absorbed.9

Scientific Findings Fructans from Jerusalem artichokes reduced insulin response, compared to fructose, an effect attributed to fructans’ slowing of GI transit time, in a small (n = 8) trial of healthy subjects.10

Jicama (Pachyrhizus erosus)

171

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Jicama (Pachyrhizus erosus)

J

Definition Also called “Mexican potato” and “yambean.” Sweet, starchy tuber11 native to Mexico and Central America pronounced “he-cama.” Jicama can weigh up to 6 pounds. It is peeled, sliced, and used as a crisp dipping vegetable. Its flavor is like a combination of water chestnut and apple and it may be used as a substitute for water chestnut in Asian cooking, such as in stir-fries. Jicama contains fewer than 25 calories per ½ cup, 2.9 g fiber (10% DV), including lignin (a type of fiber), and phenolic compounds.3,12,13

Scientific Findings In animal studies, jicama reduced serum glucose and increased insulin sensitivity.14,15 See also: Phenolic Compounds.

J

172

References

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Juniper Berry (Juniperus communis L.) Definition Cone of a shrub that has the appearance of a berry, though it is not a true berry. It contains phenolics and other phytochemicals, including limonene and myrcene.16,17 Juniper berry provides the characteristic flavor of gin. Juniperus communis has been used as a traditional cure for tuberculosis and other respiratory diseases.18

Scientific Findings Juniper has in vitro antioxidant properties that inhibit lipid peroxidation.17 Juniper berry was hepatoprotective in an animal model.19

Bioactive Dose Not known.

Safety Juniper, juniper berry, and juniper extract have Generally Recognized as Safe (GRAS) status in the US, but juniper should not be used during pregnancy because it can increase uterine tone, interfere with fertility and implantation, and cause abortion; additionally, it should not be used during lactation because there is insufficient information to evaluate its safety.20 Prolonged use of high doses can increase the potential for severe side effects such as convulsions or kidney damage.20

References 1. Cordeiro GM, Christopher MJ, Henry RJ, Reinke RF. Identification of microsatellite markers for fragrance in rice by analysis of the rice genome sequence. Mol Breed. 2002;9(4):245–250.

References

173

2. Bradbury LMT, Fitzgerald TI, Henry RJ, Jin Q, Waters DLE. The gene for fragrance in rice. Plant Biotechnol J. 2005;3(1):363–370. 3. US Department of Agriculture. Agricultural Research Service. Nutrient Data Laboratory. USDA National Nutrient Database for Standard Reference, Legacy. Version Current: April 2018. Internet: /nea/bhnrc/ndl. 4. Guerrero RTL, Gebhardt SE, Holden J, Kretsch MJ, Todd K, Novotny R, Murphy SP. White rice sold in Hawaii, Guam, and Saipan often lacks nutrient enrichment. J Am Diet Assoc. 2009;109(10):1738–1743. 5. Arnarson A. Rice 101: nutrition facts and health effects. Medical News Today 2017. www.m​edica​lnews​today​.com/​artic​les/3​18699​.php. Accessed June 25, 2018. 6. Yoneyama S, Sakurai M, Nakamura K, Morikawa Y, Miura K, Nakashima M, et al. Associations between rice, noodle, and bread intake and sleep quality in Japanese men and women. PLoS One. 2014;9(8):e105198. 7. Miller JB, Pang E, Bramall L. Rice: a high or low glycemic index food? Am J Clin Nutr. 1992;56(6);1:1034–1036. 8. Chan HM, Brand-Miller JC, Holt SH, Wilson D, Rozman M, Petocz P. The glycaemic index values of Vietnamese foods. Eur J Clin Nutr. 2001;55(12):1076–1083. 9. University of Wisconsin Agricultural Extension Service. Alternative Field Crops Manual. Jerusalem artichokes. www.h​ort.p​urdue​.edu/​newcr​op/af​cm/ je​rusar​t.htm​l. Accessed January 18, 2012. 10. Rumessen JJ, Bodé S, Hamberg O, Gudmand-Høyer E. Fructans of Jerusalem artichokes: intestinal transport, absorption, fermentation, and influence on blood glucose, insulin, and C-peptide responses in healthy subjects. Am J Clin Nutr. 1990;52:675–681. 11. Mélo EA, Stamford TL, Silva MP, Krieger N, Stamford NP. Functional properties of yam bean (Pachyrhizus erosus) starch. Bioresour Technol. 2003;89(1):103–106. 12. Produce for Better Health. Fruit and Veggies More Matters. Jicama. www. f​r uits​a ndve​ggies​morem​atter​s.org​/?pag​e_id=​1350. Accessed January 2, 2012. 13. Aquino-Bolanos EN, Mercado-Silva E. Effects of polyphenol oxidase and peroxidase activity, phenolics and lignin content on the browning of cut jicama. Postharvest Biol Tec. 2004;33(3):275–283. 14. Joo Park C, Han J-S. Hypoglycemic effect of jicama (Pachyrhizus erosus) extract on streptozotocin-induced diabetic mice. Prev Nutr Food Sci. 2015; 20(2): 88–93. 15. Park CJ, Lee HA, Han JS. Jicama (Pachyrhizus erosus) extract increases insulin sensitivity and regulates hepatic glucose in mice. J Clin Biochem Nutr. 2016; 58(1):56–63. 16. Shabmir F, Ahmadi AL, Mirza M, Korori SAA. Secretory elements of needles and berries of Juniperus communis L. ssp. communis and its volatile constituents. Flavour Frag J. 2003;18(5):425–428. 17. Elmastaşa M, Gülçinb I, Beydemirb S, İrfan Küfrevioğlub O, Aboul‐Eneinc HY. A study on the in vitro antioxidant activity of juniper (Juniperus communis L.) fruit extracts. Anal Lett. 2006;39(1):47–65. 18. Gordien AY, Gray AI, Franzblau SG, Seidel V. Antimycobacterial terpenoids from Juniperus communis L. (Cuppressaceae). J Ethnopharmacol. 2009 Dec 10;126(3):500–505.

J

J

174

References

19. Jones SM, Zhong Z, Enomoto N, Schemmer P, Thurman RG. Dietary juniper berry oil minimizes hepatic reperfusion injury in the rat. Hepatology. 1998;28(4):1042–1050. 20. Jellin JM, Gregory PJ, et al. Natural Medicine Comprehensive Database. Therapeutic Research Faculty. 2013. www.naturaldatabase.com. Accessed July 11, 2012.

K Kaempferol Definition Common dietary flavonoid found in a wide variety of plant foods such as tea, broccoli, cabbage, kale, beans, endive, leek, tomato, and strawberry.1

Scientific Findings Consuming foods containing kaempferol was associated with a reduced risk of developing cancer and cardiovascular disease in epidemiological studies.1 Kaempferol was one of several flavonoids associated inversely with lung cancer among tobacco smokers, but not among nonsmokers in a population-based case-control study (n = 558 lung cancer cases and a group of 837 controls).2

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

175

K

176

Kale (Brassica oleraceae var. acephala)

Kale (Brassica oleraceae var. acephala)

K

Definition Dark green leafy Brassica vegetable that, per ½ cup, supplies calcium (45 mg, 3% DV), folate (10 µg, 2.5% DV), magnesium (11 mg, 2% DV), and is an excellent source of vitamin A (258 μg RAE, 29% DV), vitamin C (40 mg, 44% DV), and vitamin K (273 IU, 227% DV). Lutein, xeaxanthin, and allyl isothiocyanate are among its phytochemical constituents.3,4 Fresh, cooked, and cooked frozen kale all supply approximately 45 µg of beta-cryptoxanthin per 100 g.5 Kale leaves and stems are chopped, sautéed with or without meat, and served as greens, and kale leaves can be baked into snack chips. Baby kale is more tender than kale and is used as a salad green. The leaves of curly kale (Brassica oleracea L. Convar. Acephala var. sabellica) were found to contain dozens of different phenolic compounds in a laboratory analysis.6

Key Lime (Citrus aurantifolia)

177

Scientific Findings Kale seeds exhibited antioxidant properties in vitro.7 See also: Phenolic Compounds.

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals. Kale’s thiocyanate component may induce hypothyroid effects in some individuals when kale is consumed and the amount may vary by individual.8

Key Lime (Citrus aurantifolia)

K

Definition Miniature lime named after one of the places it grows, the Florida Keys. Adds zesty flavor to marinades, salads, and Key lime pie; also used to make limeade and to flavor and garnish beverages. A good source of vitamin C and flavonoids.9

Scientific Findings Lime essential oil from lime peel reduced body weight in laboratory animals.10 Key lime inhibited the growth of antibiotic-resistant H. pylori in experimental research.11

K

178

Kombucha

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.12 Lime juice administered enterally blocked ovulation and compromised fertility in laboratory animals.13 Lime juice also reduced the effectiveness of warfarin in laboratory animals.14

Kiwifruit (Actinidia chinensis) Definition Also called kiwi. Small green- or gold-fleshed fruit that is eaten fresh and depending on the variety, is a source of vitamins C and E, phenolics, carotenoids, lutein, and xeaxanthin.15,16 When its small, edible black seeds are consumed, one small, whole kiwifruit supplies 2 g fiber (7% DV).16

Scientific Findings In experimental research, kiwifruit improved markers of immune function in mice.17 Kiwifruit polysaccharides increased fibroblast activity in an in vitro study, which may have implications for human collagen synthesis.18 Kiwi may improve laxation, aid digestion, and promote healthy gut microflora in humans, and, in addition, has antioxidant and antiplatelet aggregatory properties.19

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Kombucha Definition Fermented tea that is a source of polyphenolic compounds20 and contains bacteria and yeasts produced by fermenting sugared black tea with tea fungus.21 Kombucha tea may have Manchurian origins but has been historically consumed in China, Russia, and Germany. It has resurged to

Kombucha

179

popularity in recent years due to its purported functional properties22 including anti-inflammatory and radical scavenging.22,23

Scientific Findings “Limited evidence suggests kombucha tea may offer benefits similar to probiotic supplements, including promoting a healthy immune system and preventing constipation. At present, however, valid medical studies of kombucha tea’s role in human health are very limited,”24 and its benefits or side effects have not been widely reported.25

Bioactive Dose Not known.

Safety “There have been reports of adverse effects, such as stomach upset, infections, and allergic reactions in kombucha tea drinkers. Kombucha tea is often brewed in homes under nonsterile conditions, making contamination likely. When improperly manufactured ceramic pots have been used for brewing, lead poisoning has occurred.”24 Side effects probably related to consumption of kombucha tea are reported in four patients. Two presented with symptoms of allergic reaction, the third with jaundice, and the fourth with nausea, vomiting, and head and neck pain.25

K

180

Kumquat (Fortunella sp. Swingle, Citrus japonica var. margarita)

Kumquat (Fortunella sp. Swingle, Citrus japonica var. margarita)

K Definition Miniature orange whose thin peel is edible. Citrus peel is used in traditional medicine for digestion, severe cold, and fever.27 Kumquats are a source of flavones, vitamin C, and the carotenoids alpha-carotene, betacryptoxanthin, lutein, and xeaxanthin.28 Kumquats can be eaten raw and whole or can be used to make marmalade. Canned, peeled kumquats are often served as desserts in Chinese restaurants.

Scientific Findings Kumquat peel and pulp contain phenolic compounds and flavonoids.28 See also: Citrus Fruit, Phenolic Compounds, and Flavonoids.

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

References

181

References 1. Calderón-Montaño JM, Burgos-Morón E, Pérez-Guerrero C, López-Lázaro M. A review on the dietary flavonoid kaempferol. Mini Rev Med Chem. 2011;11(4):298–344. 2. Cui Y, Morgenstern H, Greenland S, Tashkin DP, Mao JT, Cai L, Cozen W, Mack TM, Lu QY, Zhang ZF. Dietary flavonoid intake and lung cancer—a population-based case-control study. Cancer. 2008;112(10):2241–2248. 3. US Department of Agriculture. Agricultural Research Service. Nutrient Data Laboratory. Kale, raw. www.n​al.us​da.go​v/fni​c/foo​dcomp​/cgi-​bin/l​ist_ n​ut_ed​it.pl​. Accessed January 4, 2012. 4. Fernandes F, Guedes de Pinho P, Valentão P, Pereira JA, Andrade PBVolatile constituents throughout Brassica oleracea L. var. acephala germination. J Agric Food Chem. 2009;57(15):6795–6802. 5. United States Department of Agriculture. Agricultural Research Service. USDA Food Composition Databases. Cryptoxanthin, beta (µg). https​://nd​b. nal​.usda​.gov/​n db/n​utrie​nts/r​e port​/nutr​i ents​f rm?m​a x=25​& offs​e t=0&​ totCo​u nt=0​&nutr​ient1​=334&​nutri​ent2=​&subs​et=0&​sort=​c&mea​sureb​y=g. Accessed June 29, 2018. 6. Olsen H, Aaby K, Borge GIA. Characterization and quantification of flavonoids and hydroxycinnaminic acids in curly kale (Brassica oleracea L. Convar. acephala var. sabellica) by HPLC-DAD-ESI-MS. J Agric Food Chem. 2009;57(7):2816–2825. 7. Ferreres F, Fernandes F, Sousa C, Valentão P, Pereira JA, Andrade PB. Metabolic and bioactivity insights into Brassica oleracea var acephala.. J Agric Food Chem. 2009;57(19):8884–8892. 8. Román GC. Autism: transient in utero hypothyroxinemia related to maternal flavonoid ingestion during pregnancy and to other environmental antithyroid agents. J Neurol Sci. 2007;262(1–2):15–26. 9. Martí N, Mena DP, Cánovas JA, Micol V, Saura D. Vitamin C and the role of citrus juices as functional food. Nat Prod Commun. 2009;4(5):677–700. 10. Asnaashari S, Delazar A, Habibi B, Vasfi R, Nahar L, Hamedeyazdan S, Sarker SD. Essential oil from Citrus aurantifolia prevents ketotifen-induced weight-gain in mice. Phytother Res. 2010;24(12):1893–1897. 11. Lee SM, Park SY, Kim MJ, Cho EA, Jun CH, Park CH, Kim HS, Choi SK, Rew JS. Key lime (Citrus aurantifolia) inhibits the growth of triple drug resistant Helicobacter pylori. Gut Pathog. 2018 May 21;10:16. 12. US Government Publishing Office. Food and Drugs. Substances Generally Recognized as Safe. www.e​cfr.g​ov/cg​i-bin​/text​-idx?​rgn=d​iv5&n​ode=2​1:3.0​.1.1.​ 13#se​21.3.​182_1​1. Accessed January 21, 2015. 13. Salawu AA, Osinubi AA, Dosumu OO, Kusemiju TO, Noronha CC, Okanlawon AO. Effect of the juice of lime (Citrus aurantifolia) on estrous cycle and ovulation of Sprague-Dawley rats. Endocr Pract. 2010;16(4):561–565. 14. Adepoju G, Adeyemi T. Evaluation of the effect of lime fruit juice on the anticoagulant effect of warfarin. J Young Pharm. 2010;2(3):269–272. 15. Nishiyama I, Fukuda T, Oota T. Genotypic differences in chlorophyll, lutein, and beta-carotene contents in the fruits of actinidia species. J Agric Food Chem. 2005;53(16):6403–6407.

K

K

182

References

16. US Department of Agriculture. Agricultural Research Service. Nutrient Database. Kiwifruit, green, raw. www.n​al.us​da.go​v/fni​c/foo​dcomp​/cgi-​ bin/l​ist_n​ut_ed​it.pl​. Accessed May 12, 2011. 17. Hunter DC, Denis M, Parlane NA, Buddle BM, Stevenson LM, Skinner MA. Feeding ZESPRI GOLD Kiwifruit purée to mice enhances serum immunoglobulins specific for ovalbumin and stimulates ovalbumin-specific mesenteric lymph node cell proliferation in response to orally administered ovalbumin. Nutr Res. 2008;28(4):251–257. 18. Deters AM, Schröder KR, Hensel A. Kiwi fruit (Actinidia chinensis L.) polysaccharides exert stimulating effects on cell proliferation via enhanced growth factor receptors, energy production, and collagen synthesis of human keratinocytes, fibroblasts, and skin equivalents. J Cell Physiol. 2005;202(3):717–722. 19. Skinner MA, Loh JM, Hunter DC, Zhang J. Gold kiwifruit (Actinidia chinensis ‘Hort16A’) for immune support. Proc Nutr Soc. 2011;70(2):276–280. 20. Bhattacharya D, Ghosh D, Bhattacharya S, Sarkar S, Karmakar P, Koley H, Gachhui R. Antibacterial activity of polyphenolic fraction of kombucha against Vibrio cholerae: targeting cell membrane. Lett Appl Microbiol. 2018 Feb;66(2):145–152. 21. Jayabalana R, MarimuthubS, Swaminathana K. Changes in content of organic acids and tea polyphenols during kombucha tea fermentation. Food Chem. 2007;102(1):392–398. 22. Villarreal-Soto SA, Beaufort S, Bouajila J, Souchard JP, Taillandier P. Understanding kombucha tea fermentation: a review. J Food Sci. 2018 Mar;83(3):580–588. 23. Chakravorty S, Bhattacharya S, Chatzinotas A, Chakraborty W, Bhattacharya D, Gachhui R. Kombucha tea fermentation: Microbial and biochemical dynamics. Int J Food Microbiol. 2016;220:63–72. 24. Bauer BA. What is kombucha tea? Does it have any health benefits? www. m ​ayocl ​ i nic.​ org/h​ e alth​ y-lif​ e styl​ e/con ​ sumer​ -heal​t h/ex ​p ert- ​a nswe​r s/ko​ mbuch​a-tea​/faq-​20058​126. Accessed August 20, 2018. 25. Srinivasan R, Smolinske S, Greenbaum D. Probable gastrointestinal toxicity of kombucha tea: is this beverage healthy or harmful? J Gen Int Med. 2002;12(10):643–645. 26. Yang EJ, Kim SS, Moon JY, Oh TH, Baik JS, Lee NH, Hyun CG. Inhibitory effects of Fortunella japonica var. margarita and Citrus sunki essential oils on nitric oxide production and skin pathogens. Acta Microbiol Immunol Hung. 2010 Mar;57(1):15–27. 27. US Department of Agriculture Agricultural Research Service. National Nutrient Database. Kumquats, fresh. www.n​al.us​da.go​v/fni​c/foo​dcomp​/ cgi-​bin/l​ist_n​ut_ed​it.pl​. Accessed January 4, 2012. 28. Lou SN, Lai YC, Hsu YS, Ho CT. Phenolic content, antioxidant activity and effective compounds of kumquat extracted by different solvents. Food Chem. 2016 Apr 15;197(Pt A):1–6.

L Lactose Definition Disaccharide that is unique to milk and found in lesser amounts in yogurt and cheese. It is separated from milk or whey and used as a food additive in processed foods because it is an inexpensive bulking agent. When a lactose-containing food additive has been added to a food, it will appear on the “ingredients” list, but it may be difficult to identify: for example, sodium caseinate, a common food additive, contains lactose (caseinate is derived from casein, a milk component).1 Foods such as breakfast cereals, sliced bread, and cake mixes; salad dressing and prepared sauces; processed meats (sausage, hot dogs, and sliced meat); restaurant foods, e.g., McDonald’s® hotcakes, prepared meals, e.g., Hot Pockets® sandwiches; candy, e.g., Tootsie Rolls® and many other foods contain added lactose (Table L.1). Approximately 20% of prescription drug products and 5% of over-the-counter drug products contain lactose.2 Lactose is digested by lactase on the jejunum brush border into glucose and galactose. When lactase activity is deficient or absent, lactose maldigestion occurs and undigested lactose travels to the colon where, as an osmotically active particle, it attracts water, possibly resulting in loose stools; as well, colonic bacteria feed upon the sugar, forming gas, leading to abdominal pain, bloating, and other undesirable gastrointestinal symptoms. Up to 75% of all people worldwide are lactose intolerant.

Scientific Findings Lactose improves the absorption of calcium and magnesium and, because it is an undigested substance in the colon of lactose-intolerant individuals, it serves as food for bacteria, thereby meeting the definition of a “prebiotic,” favoring the growth of bifidobacteria and lactobacilli (but with concomitant undesirable GI effects).3,4 Breakdown of lactose in the large intestine can cause these desirable effects: formation of fatty acids, reduction of luminal pH, decreased formation of toxic secondary bile acids, and suppressed formation of toxic bacterial metabolites such as ammonia.5 Lactose intolerance is a risk factor for low bone density5 because milk avoidance limits calcium and vitamin D consumption.6 183

L

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184

Legume Table L.1  Lactose in Common Foods

Food 1% milk Nonfat Greek-style vanilla yogurt Hot Pockets® Ham and Cheese Stuffed Sandwich Cream cheese, fat-free McDonald’s, Hotcakes (with 2 pats margarine & syrup)

Portion size

Lactose, g

8 oz 8 oz 127 g

12.69 6.53 3.01

1 tablespoon 1 order

0.87 5.26

Source:  78

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals. The Surgeon General’s 2004 Report on Bone Health and Osteoporosis indicates that an estimated 30–50 million Americans are affected by lactose intolerance who may experience gastrointestinal adverse effects after consuming even minute amounts of lactose.

Legume Definition Fabaceae, also called Leguminosae, family vegetable that is an excellent source of fiber (7 g, 25% DV), iron (5 mg, 27% DV) and magnesium (109 mg, 25% DV) and a good source of protein (7 g, 14% DV) and folate (60 µg, 15% DV) (per ½ cup of baked beans).7 Additionally, legumes supply small amounts of zinc, copper, and manganese.8 One-quarter (¼) cup of legumes, including lentils, black/garbanzo/kidney/pinto/lima/soy beans (but not string beans), black-eyed or green peas (but not snap peas or snow peas), or other starchy beans, is considered to be nutritionally equivalent to 1 oz of meat/fish/poultry, 1 egg, ¼ cup of tofu, ½ oz of nuts, or 1 tablespoon of peanut butter in the USDA ChooseMyPlate.gov model. Only 7.9% of Americans may consume legumes on a daily basis.9 Phytochemicals in legumes include enzyme inhibitors, phytohemagglutinins (lectins), phytoestrogens, oligosaccharides, saponins, and phenolic compounds.10

Lemon (Citrus limon)

185

Scientific Findings A meta-analysis of six prospective cohort studies (n = approximately 21,899 adults aged 20–86 primarily residing in Asian countries) examining highest intake with lowest intake of legume consumption (average length of follow-up 12 years) found high legume intake was associated with lower risk of all-cause mortality; however, no significant relationship between legume consumption and cardiovascular disease (CVD) mortality was found.11 A longitudinal cohort study (n = 7,216 elderly Mediterranean individuals at high CVD risk, median follow-up of 6 y) found that higher total legume consumption was associated with a 49% lower risk of cancer mortality.12 Legumes may help to control blood sugar in people with diabetes,13 perhaps due to their high soluble fiber content and/or their low glycemic index. Hemoglobin A1c (HbA1c) decreased by 0.5%, a statistically significant decrease, with a low glycemic index diet, compared to a high glycemic index diet in an analysis of 11 RCTs lasting 1–12 months (n = 402 subjects with diabetes mellitus); additionally, hypoglycemic episodes significantly decreased with a low glycemic index diet compared to high glycemic index diet.13

Bioactive Dose While there is no daily recommendation for legumes per se, ChooseMyPlate.gov promotes legume consumption and suggests adults aged 19–50 ingest 5–6.5 oz-equivalents daily (a 1-oz equivalent = ¼ cup of cooked beans), depending on age, from all protein sources including legumes.14 The Mediterranean Diet includes 1 and a ½ cups of legumes/ peas/beans weekly.15

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Lemon (Citrus limon) Definition Tangy, sour citrus fruit used on seafood and to make sauces, drinks, and marinades. Its citrate content is the highest among citrus fruits.16 Lemon juice is a good source of vitamin C (11.8 mg, 13% DV per 1 tablespoon) and supplies liminoid, beta-cryptoxanthin, lutein, xeaxanthin, coumarins, hesperetin, quercetin, and myricetin.17,18

L

L

186

Lemongrass (Cymbopogon citratus)

Scientific Findings Lemon essential oil, from lemon peel, when sprayed as an aerosol, reduced Staphylococci, Streptococci, and Sarcina in the air.19 In a small prospective, crossover-design trial (n = 21 subjects at risk for kidney stone formation), drinking lemonade corrected one of three markers of improvement, urine volume, but not urinary citrate or uric acid level.20 A second small trial (n = 12 patients) found that citrate supplementation with lemonade improved urinary citrate, but not total urinary volume.21 In a third 44-month trial (n = 11), 10 of the hypocitraturic patients experienced a significant decrease in stone formation during lemonade therapy.17 An experimental study found coumarins in lemon peel inhibited free radical generation.22 A dietary deficiency of hesperidin has been associated with capillary fragility and extremity pain causing night leg cramps, according to a review of its pharmacologic properties.8 Hesperidin exhibited antiinflammatory, hypolipidemic, and vasoprotective properties in experimental studies and several small clinical trials.8 Hesperidin may improve venous diseases, such as hemorrhoids23 and venous stasis, possibly by reducing capillary permeability.24,25

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Lemongrass (Cymbopogon citratus)

Lettuce (Lactuca sativa)

187

Definition Small hard stalk that is a tropical grass. It may be chopped finely and used for its intense lemon flavor in Thai cooking. Lemongrass tea has been used in traditional medicine to treat hypertension and diabetes.26

Scientific Findings Lemongrass essential oil, when sprayed as an aerosol, reduced airborne microorganism contaminants.26 Laboratory research suggests that antiinflammatory compounds in lemongrass work by inhibiting the release of pro-inflammatory cytokines.27 Lemongrass attenuated animal liver damage in an experimental study.28

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Lettuce (Lactuca sativa) Definition Salad green, such as the Bibb variety, that grows in small, loose heads and is an excellent source of vitamin K (56 µg, 46% DV per 1 cup);29 lola rosa (also spelled lola rossa and lolla rosa), a mild-flavored, looseleaf Italian variety with ruffled burgundy leaves that is frequently included in spring mix and is a rich source of anthocyanins that are concentrated in its intense red-pigmented parts;30–34 and lollo biondo, the green-leafed sister of lola rosa, that has been described as “pleasantly strong and nutty,” although slightly bitter.35 Lola rosa may originate from Lactuca serriola, “a wild species found throughout Europe, Asia, and North Africa,” and possibly first cultivated by the ancient Egyptians who believed it was an aphrodisiac and remedy for stomach ache.33 Lactuca, the Roman name for lettuce, comes from “lac” (milk) because wild lettuce contains a milky sap.32,33 Lettuce was traditionally eaten at the end of the evening meal because it was thought to produce a mild, sedative effect, though it may also have been eaten at the beginning of a meal to enhance appetite.35

L

L

188

Lignan

Scientific Findings In animal studies, a lettuce-derived protein elicited antibodies with positive reactivity against Human Immunodeficiency Virus, as well as systemic and local immune responses.36 Lettuce intake correlated with higher serum carotenoid concentrations, specifically of xeaxanthin and beta-cryptoxanthin, in postmenopausal osteoporotic women (n = 59), a subgroup that may have compromised antioxidant defenses.37

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Lignan Definition Phytoestrogen that is abundant in the Western diet as are its metabolites enterolactone and enterodiol.38,39 Lignan is found in flaxseed, pumpkin seed, sesame seed, soybean, broccoli, whole grains, beans, peas, and some berries.36,40 Lignan is different than lignin; the latter is a type of dietary fiber.41

Scientific Findings A meta-analysis of 21 epidemiologic studies concluded that high lignan exposure is associated with a reduced breast cancer risk in postmenopausal women.35 GI microorganisms interacting with lignan enterodiol and enterolactone have generated bioactive compounds that retarded experimentally induced cancer.42 “Ecological data suggest a long-term diet high in plant material rich in biologically active compounds, such as the lignans, can significantly influence the development of prostate cancer over the lifetime of an individual.”43

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Lingonberry (Vaccinium vitis-idaea)

189

Limonene Definition One of the most common terpenes in nature found in high concentration in orange, lemon, mandarin, lime, and grapefruit oils.44 Ingested when the peel or “zest” of citrus fruits is consumed and used as a flavoring agent in fruit juices, soft drinks, baked goods, ice cream, and pudding.

Scientific Findings Limonene has exerted chemopreventative and chemotherapeutic properties in human tumor cell lines and animal models.45–47

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Lingonberry (Vaccinium vitis-idaea) Definition Relative of a cranberry that grows in Europe, Asia, and North America. Consumed as preserves, dried, as a powdered drink additive, frozen, and as juice. A rich source of phenolic compounds, such as anthocyanins, procyanidins, flavonols, and catechins,48,49 “Lingonberry grows in unfavorable climates where ‘any palatable fruit is appreciated’ and it was considered so important in 13th Century Iceland that laws limited berrypicking on other people’s lands to what could be eaten on the spot.”50

Scientific Findings In laboratory studies, the phenolics in lingonberries were effective free radical scavengers45 and antimicrobial against Staphylococcus aureus.51 Cranberry-lingonberry juice dosed at 50 ml daily for 6 months resulted in a significant reduction in recurrence of urinary tract infection (UTI) compared to 100 ml of Lactobacillus drink 5 days a week for one year, or no intervention, in a small randomized intervention study (n = 150 women with UTI).52 Lingonberry extract reduced oxidative stress and exerted neuroprotective effects in diabetic rats.53

L

L

190

Lutein

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Lipid Definition Water-insoluble macronutrient that supplies 9 kcalories/g making it the most calorically dense macronutrient. Found in plant oils and animal fats, its roles in foods include improving palatability, flavor, and aroma; serving as a source of essential fatty acids and energy and as a source of fatsoluble vitamins and phytochemicals.

Scientific Findings See: Omega-3-Fatty Acid, Omega-6-Fatty Acid.

Bioactive Dose The AMDR for lipid is 20 35% of daily kcalories. See also: Docosahexaenoic Acid, Eicosapentaenoic Acid, Omega-3-Fatty Acid and Omega-6-Fatty Acid.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Lutein Definition Xanthophyll carotenoid that commonly occurs with xeaxanthin in foods, such as green vegetables, that are among the richest sources. Lutein and xeaxanthin are major dietary and serum carotenoids that impart a yellow pigment to foods and the macula region of the retina (Table L.2).54

Scientific Findings Macular pigment may protect retinal cells from damage by absorbing blue light, and a low-density of macular pigment is thought to increase risk for

Lutein

191 Table L.2  Lutein + Xeaxanthin Content, µg79,80

Kale, cooked, 1 cup Spinach, raw, 1 cup Green peas, canned, 1 cup Corn, creamed, canned, 1 cup Broccoli, frozen, cooked, 1 cup Centrum Silver 50 Plus®, 1 tablet

5,880 lutein + xeaxanthin 3,659 lutein + xeaxanthin 4,332 lutein + xeaxanthin 2,428 lutein + xeaxanthin 2,015 lutein + xeaxanthin 250 lutein (referred to as “lutein + xeaxanthin” on product literature, but as “lutein” on the Supplement Facts panel)

age-related macular degeneration (AMD).55 Ample epidemiological evidence suggests that the amount of macular pigment is inversely associated with the incidence of AMD.54 AMD is an irreversible process that is a major cause of blindness in the elderly.54 A meta-analysis of six longitudinal cohort studies reported that dietary intake of lutein and xeaxanthin was not associated with a reduced risk of early AMD, but that dietary intake of lutein and xeaxanthin was significantly associated with a reduction in the risk of late AMD.56 A meta-analysis of five RCTs (n = 76,756 healthy people who did not yet have AMD) ranging in duration from 6 months to 6 years concluded that dietary supplements of lutein had little or no effect on AMD progression, but concluded that it is possible that antioxidant vitamins may help to protect the macula against deterioration and loss of vision.57 People consuming 6.9–11.69 mg of lutein and xeaxanthin as determined by food frequency questionnaire, which assesses usual intake, had a modestly lower risk of developing cataracts, according to two large cohort studies (n = 36,644 men58 where lutein and xeaxanthin intake included dietary supplements; n = 77,466 women59 where lutein and xeaxanthin intake did not include dietary supplements). Foods associated with lower risk of cataract in one or both studies included broccoli, spinach, and/or kale.58,59

Bioactive Dose Routinely consuming 6.9 mg (6,900 μg)–11.7 mg (11,696 μg) of lutein and xeaxanthin was associated with a modest reduction in cataract development.57,58

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

L

L

192

Lychee Fruit (Litchi chinensis)

Lychee Fruit (Litchi chinensis)

Definition Also spelled litchi. Golf ball sized fruit whose white or pinkish-white flesh “tastes a grape, but with a stronger, slightly acidic touch.”60 Raw lychee fruit contains vitamin C (6.9 mg, 7% DV) per 1 fruit, and is a source of flavonoids, sterols, and triterpenes.61–63 Fresh and peeled, pitted lychees canned in syrup are available in Asian food stores, and fresh lychees have been used to make novelty mixed alcoholic drinks.59 Lychee has been used in traditional Asian medicine for the treatment of a cough, flatulence, stomach ulcers, diabetes, obesity, testicular swelling, hernia-like conditions, epigastric and neuralgic pains; and it has been used as a hypoglycemic, cancer-preventative, antibacterial, antihyperlipidemic, antiplatelet aggregatory, antitussive, analgesic, antipyretic, hemostatic, diuretic, and antiviral agent.60

Scientific Findings Polyphenolic compounds from lychee fruits were strong antioxidants in laboratory studies.59 Lychee flavonoids exerted immunomodulatory and anticancer activities in vitro.64

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals; litchi fruit juice and extracts have been proven to be safe at a dose 1 g/kg.60

Lycopene (Solanum lycopersicum)

193

Lycopene (Solanum lycopersicum) Definition Carotenoid antioxidant that imparts pink and red pigment to certain fruits and vegetables such as watermelon, pink grapefruit, guava, and tomatoes. Approximately 85% of the dietary lycopene intake in the US is from tomatoes (Table L.3).65

Scientific Findings Lycopene laboratory studies suggest it may help to alleviate cellular oxidative stress.66 Observational studies have shown that the risk for some types of cancer is lower in individuals who have higher levels of lycopene in their blood;67 however, in reviewing lycopene for qualified health claim status, FDA found no association between lycopene intake and reduced risk of breast, colorectal, endometrial, gastric, lung, ovarian, prostate, or pancreatic cancer.68 Lycopene induces beneficial responses in human prostate epithelial cells that are antiproliferative, antioxidative, antiinflammatory, and androgen regulatory.69 Two meta-analyses (n = 592,479; n = 563,299) 70,71 found that lycopene intake was inversely associated with the risk of prostate cancer (note: these two studies, published in the same year, analyzed some of the same clinical trials). In the Health Professionals Follow-Up Study, subjects free of diagnosed prostate cancer (n = 47,894) in the highest quintile of lycopene intake who consumed > 10 servings a week of tomatoes, tomato sauce, tomato juice, pizza, had a lower risk of developing prostate cancer than those who consumed fewer than 1.5 servings per week (Table L.4).72 The Prostate Cancer Prevention Trial (n = 9,559 participants) observed no association between food lycopene or lycopene from dietary supplements and prostate cancer risk.73 A meta-analysis of three randomized clinical trials RCTs (n = 154 participants),74–76 found no statistical difference in PSA levels between men randomized to receive lycopene supplements [8 mg for 1 year, 15 mg for 6 months; or 30 mg for 4 months] and the comparison groups, and “insufficient evidence to either support, or refute, Table L.3  Lycopene Content, µg81 Tomato soup, canned, 1 cup Spaghetti, with meatballs in tomato sauce, canned, 1 cup Watermelon, fresh, 1 cup Ketchup, 1 tablespoon Cranberry sauce, 1 cup General Nutrition Centers Mega-Men® Dietary Supplement, 1 caplet

16,162 8,494 6,979 2,051 0 500

L

L

194

References Table L.4  Example of > 10 Servings of Tomato Products

Western Omelet made with 1 small tomato (1 serving) Large salad made with 1 small tomato (1 serving) 2 cups of chili made with 1 cup tomatoes/sauce/paste (1 serving) 4 slices of pizza (1–2 servings) 4 cups of pasta with 4 cups of marinara sauce (4 servings) and salad with 4 tomato wedges (0.5 serving) 1 large meatball submarine sandwich with sauce, lettuce, and tomato (1–1.5 servings) 8 oz tomato juice or V-8® (1 serving)

the use of lycopene supplements for the prevention of prostate cancer” as well as no robust evidence from RCTs to assess the impact of lycopene consumption on incidence of prostate cancer, prostate symptoms, or PSA levels.”77

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

References

1. US Food & Drug Administration. Problems digesting dairy products? www. f​da.go​v/For​Consu​mers/​Consu​merUp​dates​/ucm0​94550​.htm. Accessed July 7, 2018. 2. Whitney E, Rolfes SR. Understanding Nutrition. 11th edn. Belmont, CA: Thomson Higher Education; 2008. 3. Cámara-Martos F, Amaro-López MA. Influence of dietary factors on calcium bioavailability: a brief review. Biol Trace Elem Res. 2002;89(1):43–52. 4. Schaafsma G. Lactose and lactose derivatives as bioactive ingredients in human nutrition. Int Dairy J. 2008;5:458–465. 5. Savaiano D. Lactose intolerance: an unnecessary risk for low bone density. Nestle Nutr Workshop Ser Pediatr Program. 2011;67:161–171. 6. Institute of Medicine. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington, DC: National Academy Press; 1997. 7. Pennington JAT. Bowe’s & Church’s Food Values of Portions Commonly Used. 17th edn. Philadelphia:Lippincott, Williams & Wilkins. 8. US Department of Health and Human Services and US Department of Agriculture. 2015–2020 Dietary Guidelines for Americans. 8th edn. December 2015. http:​//hea​lth.g​ov/di​etary​guide​lines​/2015​/guid​eline​s/.

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9. Mitchell DC, Lawrence FR, Hartman TJ, Curran JM. Consumption of dry beans, peas, and lentils could improve diet quality in the US population. J Am Diet Assoc. 2009;109(5):909–913. 10. Huang WY, Davidge ST, Wu J. Bioactive natural constituents from food sources-potential use in hypertension prevention and treatment. Crit Rev Food Sci Nutr. 2013;53(6):615–630. 11. Li H, Li J, Shen Y, Wang J, Zhou D. Legume consumption and all-cause and cardiovascular disease mortality. Biomed Res Int. 2017;2017:8450618. 12. Papandreou C, Becerra-Tomás N, Bulló M, Martínez-González MÁ, Corella D, Estruch R, Ros E, Arós F, Schröder H, Fitó M, Serra-Majem L, Lapetra J, Fiol M, Ruiz-Canela M, Sorlí JV, Salas-Salvadó J. Legume consumption and risk of all-cause, cardiovascular, and cancer mortality in the PREDIMED study. Clin Nutr. 2018 Jan 9. pii: S0261–5614(17)31439–5. 13. No author. Beans may help control blood sugar in people with diabetes. Harv Health Lett. 2013;38(3):8. 14. US Department of Agriculture. ChooseMyPlate.gov. How much food from the protein foods group is needed daily? http:​//myp​late.​gov/p​rintp​ages/​ MyPla​teFoo​dGrou​ps/Pr​otein ​Foods​/food​-grou​ps.pr​otein​-food​s -amo​u nt. p​df. Accessed July 28, 2013. 15. US Department of Health and Human Services and US Department of Agriculture 2015–2020 Dietary Guidelines for Americans. 8th edn. December 2015. https​://he​alth.​gov/d​ietar​yguid​eline​s/201​5/. 16. Kang DE, Sur RL, Haleblian GE, Fitzsimons NJ, Borawski KM, Preminger GM. Long-term lemonade based dietary manipulation in patients with hypocitraturic nephrolithiasis. J Urol. 2007;177(4):1358–1362. 17. US Department of Agriculture. Agricultural Research Service. Nutrient Data Laboratory. Lemon juice, raw. http:​//ndb​.nal.​usda.​gov/n​db/fo​ods/ s​how/2​274?f​g=&ma​n=&lf​acet=​&form​at=&c​ount=​&max=​25&of​fset=​&sort​ =&qlo​okup=​lemon​+juic​e. Accessed January 8, 2012. 18. US Department of Agriculture. Agricultural Research Center. Phytochemical Database. Citrus limon. www.p​l.bar​c.usd​a.gov​/usda​_rrcp​/rrec​ipe_d​etail​ .cfm?​code=​69685​564&i​d=62&​ThisN​ame=s​d1. Accessed January 8, 2012. 19. Janssen AM, Scheffer JJC, Svendsen AB. Antimicrobial activities of essential oils. A 1976–1986 literature review on possible applications. Pharm Weekbl. 1987;9:193–197. 20. Koff SG, Paquette EL, Cullen J, Gancarczyk KK, Tucciarone PR, Schenkman NS. Comparison between lemonade and potassium citrate and impact on urine pH and 24-hour urine parameters in patients with kidney stone formation. Urology. 2007;69(6):1013–1016. 21. Seltzer MA, Low RK, McDonald M, Shami GS, Stoller ML. Dietary manipulation with lemonade to treat hypocitraturic calcium nephrolithiasis. J Urol. 1996;156(3):907–909. 22. Miyake Y, Murakami A, Sugiyama Y, Isobe M, Koshimizu K, Ohigashi H. Identification of coumarins from lemon fruit (Citrus limon) as inhibitors of in vitro tumor promotion and superoxide and nitric oxide generation. J Agr Food Chem. 1999;47(8):3151–3317. 23. Cospite M., Double-blind placebo-controlled evaluation of clinical activity and safety of Daflon 500 mg in the treatment of acute hemorrhoids. Angiology. 1994; 45(6 Pt 2):566–573.

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196

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24. Ramelet AA. Clinical benefits of Daflon 500 mg in the most severe stages of chronic venous insufficiency. Angiology. 2000;52(Suppl 1): S49–S56. 25. Struckmann JR, Nicolaides AN. Flavonoids. A review of the pharmacology and therapeutic efficacy of Daflon 500 mg in patients with chronic venous insufficiency and related disorders. Angiology. 1994;45(6):419–428. 26. Campos J, Schmeda-Hirschmann G, Leiva E, Guzmán L, Orrego R, Fernández P, González M, Radojkovic C, Zuñiga FA, Lamperti L, Pastene E, Aguayo C. Lemongrass (Cymbopogon citratus (DC) Stapf) polyphenols protect human umbilical vein endothelial cell (HUVECs) from oxidative damage induced by high glucose, hydrogen peroxide and oxidised low-density lipoprotein. Food Chem. 2014;15(151):175–181. 27. Salim E, Kumolosasi E, Jantan I. Inhibitory effect of selected medicinal plants on the release of pro-inflammatory cytokines in lipopolysaccharidestimulated human peripheral blood mononuclear cells. J Nat Med. 2014 May 6;68(3):647–653. 28. Rahim SM, Taha EM, Al-janabi MS, Al-douri BI, Simon KD, Mazlan AG. Hepatoprotective effect of Cymbopogon citratus aqueous extract against hydrogen peroxide-induced liver injury in male rats. Afr J Tradit Complement Altern Med. 2014;11(2):447–451. 29. US Department of Agriculture. Agricultural Research Service. National Nutrient Database. Bibb Lettuce. www.n​al.us​da.go​v/fni​c/foo​dcomp​/cgi-​ bin/l​ist_n​ut_ed​it.pl​. Accessed March 23, 2011. 30. Crozier AK, Lean MEJ, McDonald MS, Black C. Quantitative analysis of the flavonoid content of commercial tomatoes, onions, lettuce, and celery. J Agric Food Chem. 1997;45(3):590–595. 31. Koudela MK, Petříková K, Nutrients content and yield in selected cultivars of leaf lettuce (Lactuca sativa L. var. crispa). Hort Sci (Prague). 2008;35(3):99–106. 32. US Department of Agriculture. Agricultural Research Service. Nutrient Data Lab. Red leaf lettuce. www.n​al.us​da.go​v/fni​c/foo​dcomp​/cgi-​bin/l​ist_ n​ut_ed​it.pl​. Accessed January 8, 2012. 33. Lazic B, Lazic S, Sekulic P. Effect of Species and variety on the content of macroelements and micronutrients in lettuce. Acta Hort (ISHS). 2002;579:609–612. www.actahort.org/books/579/579_107.htm. Accessed July 11, 2010. 34. US Department of Agriculture. Agricultural Research Service. Phytochemical Database. Lactuca sativa (Romaine Lettuce). www.p​l.bar​c.usd​ a.gov​/usda​_ rrcp​/rrec​ipe_d​etail​.cfm?​code=​69685​564&i​d=55&​T hisN​a me=s​ d1. Accessed January 8, 2012. 35. Nolte K. Yuma County Cooperative Extension. Lolla rosa. https​://ca​ls.ar​ izona​. edu/​f ps/s​ites/​c als.​a rizo​n a.ed​u .fps​/file​s/cot​w/Lol​l a_Ro​s a.pd​f. Accessed June 29, 2018. 36. Govea-Alonso DO, Rubio-Infante N, García-Hernández AL, Varona-Santos JT, Korban SS, Moreno-Fierros L, Rosales-Mendoza S. Immunogenic properties of a lettuce-derived C4(V3)6 multiepitopic HIV protein. Planta. 2013 Jul 30;238(4):785–792. 37. Yang Z, Zhang Z, Penniston KL, Binkley N, Tanumihardjo SA. Serum carotenoid concentrations in postmenopausal women from the United States with and without osteoporosis. Int J Vitam Nutr Res. 2008;78(3):105–111. 38. Buck K, Zaineddin AK, Vrieling A, Linseis en J, Chang-Claude J. Metaanalyses of lignans and enterolignans in relation to breast cancer risk. Am J Clin Nutr. 2010;92(1):141–153.

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39. Birt DF, Shull JD, Yaktine AL. Chemoprevention of cancer. In: Modern Nutrition in Health and Disease. Shils ME, Olson JA, Shike M, Ross CA, eds. 9th edn. Baltimore, MD: Williams and Wilkins; 1998. 40. Touré A, Xueming X. Flaxseed lignans: source, biosynthesis, metabolism, antioxidant activity, bio-active components, and health benefits. Comp Rev Food Sci. 2010;9(3):261–269. 41. Nie Y, Lin Q, Luo F. Effects of non-starch polysaccharides on inflammatory bowel disease. Int J Mol Sci. 2017;18(7). pii: E1372. 42. Davis CD, Milner JA. Gastrointestinal microflora, food components and colon cancer prevention. J Nutr Biochem. 2009;20(10):743–752. 43. McCann MJ, Gill CI, Linton T, Berrar D, McGlynn H, Rowland IR. Enterolactone restricts the proliferation of the LNCaP human prostate cancer cell line in vitro. Mol Nutr Food Res. 2008 May;52(5):567–580. 44. Sun J. D-Limonene: safety and clinical applications. Altern Med Rev. 2007;12(3):259–264. 45. Crowell PL. Monoterpenes in breast cancer chemoprevention. Breast Cancer Res Treat. 1997;46(2–3):191–197. 46. Miller JA, Hakim IA, Chew W, Thompson P, Thomson CA, Chow HH. Adipose tissue accumulation of d-limonene with the consumption of a lemonade preparation rich in d-limonene content. Nutr Cancer. 2010;62(6):783–788. 47. Manassero CA, Girotti HR, Mijailovsky S, García de Bravo M, Polo M.In vitro comparative analysis of antiproliferative activity of essential oil from mandarin peel and its principal component limonene. Nat Prod Res. 2013;27(16): 1475–1478. 48. Zheng W, Wang SY. Oxygen radical absorbing capacity of phenolics in blueberries, cranberries, chokeberries, and lingonberries. J Agric Food Chem. 2003;51(2):502–509. 49. Ek S, Kartimo H, Mattila S, Tolonen A. Characterization of phenolic compounds from lingonberry (Vaccinium vitis-idaea). J Agric Food Chem. 2006;54(26):9834–9842. 50. Reich L. Lingonberry: Dainty Looks, Sturdy Disposition, and Tasty Berries. Uncommon Fruits for Every Garden. Portland, OR: Timber Press; 2004. 51. Kylli P, Nohynek L, Puupponen-Pimiä R, Westerlund-Wikström B, Leppänen T, Welling J, Moilanen E, Heinonen M. Lingonberry (Vaccinium vitis-idaea) and European cranberry (Vaccinium microcarpon) proanthocyanidins: isolation, identification, and bioactivities. J Agric Food Chem. 2011;59(7):3373–3384. 52. Kontiokari T, Sundqvist K, Nuutinen M, Pokka T, Koskela M, Uhari M. Randomised trial of cranberry-lingonberry juice and Lactobacillus GG drink for the prevention of urinary tract infections in women. BMJ. 2001;322(7302):1571. 53. Reichert KP, Schetinger MRC, Gutierres JM, Pelinson LP, Stefanello N, Dalenogare DP, Baldissarelli J, Lopes TF, Morsch VM. Lingonberry extract provides neuroprotection by regulating the purinergic system and reducing oxidative stress in diabetic rats. Mol Nutr Food Res. 2018 Jun 11:e1800050. 54. Krinsky NI, Landrum JT, Bone RA. Biologic mechanisms of the protective role of lutein and zeaxanthin in the eye. Ann Rev Nutr 2003;23:171–201. 55. Landrum JT, Bone RA, Joa HJ, Kilburn MA, Moore LL, Sprague KA. A one year study of the macular pigment: the effect of 140 days of a lutein supplement. Experimental Eye Res. 1997;65(1):57–62.

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56. Ma L, Dou HL, Wu YQ, Huang YM, Xu XR, Zou ZY, Lin XM. Lutein and zeaxanthin intake and the risk of age-related macular degeneration: a systematic review and meta-analysis. Br J Nutr. 2011;107(3):350–359. 57. Evans JR, Lawrenson JG. Antioxidant vitamin and mineral supplements for preventing age-related macular degeneration. Cochrane Database Syst Rev. 2017;7:CD000253. 58. Brown L, Rimm EB, Seddon JM, Giovannucci EL, Chasan-Taber L, Spiegelman D, Willett WC, Hankinson SE. A prospective study of carotenoid intake and risk of cataract extraction in US men. Am J Clin Nutr. 1999;70(4):517–524. 59. Chasan-Taber L, Willett WC, Seddon JM, Stampfer MJ, Rosner B, Colditz GA, Speizer FE, Hankinson SE. A prospective study of carotenoid intake and risk of cataract extraction in US men. Am J Clin Nutr. 1999;70:509–516. 60. Shaw-Tulane, G. Spoon University. What is a lychee and what does it taste like? https​://sp​oonun​ivers​ity.c​om/li​festy​le/wh​at-is​-lych​ee-an​d-wha​t-doe​s -it-​taste​-like​. Accessed July 6, 2018. 61. US Department of Agriculture. Agricultural Research Service. Nutrient Data Laboratory. Litchee fruit. http:​//ndb​.nal.​usda.​gov/n​db/fo​ods/s​how/ 2​281?f​g=&ma​n=&lf​acet=​&form​at=&c​ount=​&max=​25&of​fset=​&sort​=&qlo​ okup=​lyche​e+fru​it. Accessed July 7, 2013. 62. Purdue University Center for New Crops and Plant Products. Lychee Litchi chinensis Sonn. Nephelium litchi Cambess. http:​//www​.hort​.purd​ue.ed​u/ new​crop/​morto​n/lyc​hee.h​t ml. Accessed January 8, 2012. 63. Ibrahim SR, Mohamed GA. Litchi chinensis: medicinal uses, phytochemistry, and pharmacology. J Ethnopharmacol. 2015;174:492–513. 64. Zhao M, Yang B, Wang J, Liu Y, Yu L, Jiang Y. Immunomodulatory and anticancer activities of flavonoids extracted from litchi (Litchi chinensis Sonn.) pericarp. Int Immunopharmacol. 2007;7(1):162–166. 65. US National Library of Medicine. National Institutes of Health. Medline Plus. Lycopene. www.n​lm.ni​h.gov​/medl​inepl​us/dr​uginf​o/nat​ural/​554.h​tml. Accessed March 16, 2011. 66. Chen J, Song Y, Zhang L. Effect of lycopene supplementation on oxidative stress: an exploratory systematic review and meta-analysis of randomized controlled trials. J Med Food. 2013;16(5):361–374. 67. American Cancer Society. Lycopene. www.c​ancer​.org/​Treat​ment/​Treat​ ments​andSi​deEff​ects/​Compl​ement​aryan​dAlte​rnati​veMed​icine​/Diet​andNu​ triti​on/ly​copen​e. Accessed January 29, 2012. 68. Kavanaugh CJ, Trumbo PR, Ellwood KC. The US Food and Drug Administration’s evidence-based review for qualified health claims: tomatoes, lycopene, and cancer. J Natl Cancer Inst. 2007;99(14):1074–1085. 69. Sporn MB, Liby KT. Is lycopene an effective agent for preventing prostate cancer? Cancer Prev Res (Phila). 2013;6(5):384–386. 70. Wang Y, Cui R, Xiao Y, Fang J, Xu Q. Effect of carotene and lycopene on the risk of prostate cancer: a systematic review and dose-response meta-analysis of observational studies. PLoS One. 2015;10(9):e0137427. 71. Chen P, Zhang W, Wang X, Zhao K, Negi DS, Zhuo L, Qi M, Wang X, Zhang X. Lycopene and risk of prostate cancer: a systematic review and meta-analysis. Medicine (Baltimore). 2015;94(33):e1260. 72. Giovannucci E, Ascherio A, Rimm EB, Stampfer MJ, Colditz GA, Willett WC. Intake of carotenoids and retinol in relation to risk of prostate cancer. J Natl Cancer Inst. 1995;87(23):1767–1776.

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73. Kristal AR, Arnold KB, Neuhouser ML, Goodman P, Platz EA, Albanes D, Thompson IM. Diet, supplement use, and prostate cancer risk: results from the prostate cancer prevention trial. Am J Epidemiol. 2010;172(5):566–577. 74. Mohanty NK, Saxena S, Singh UP, Goyal NK, Arora RP. Lycopene as a chemopreventive agent in the treatment of high-grade prostate intraepithelial neoplasia. Urol Oncol. 2005;23(6):383–385. 75. Schwarz S, Obermüller-Jevic UC, Hellmis E, Koch W, Jacobi G, Biesalski HK. Lycopene inhibits disease progression in patients with benign prostate hyperplasia. J Nutr. 2008;138(1):49–53. 76. Bunker CH, McDonald AC, Evans RW, de la Rosa N, Boumosleh JM, Patrick AL. A randomized trial of lycopene supplementation in Tobago men with high prostate cancer risk. Nutr Cancer. 2007;57(2):130–137. 77. Ilic D, Forbes KM, Hassed C. Lycopene for the prevention of prostate cancer. Cochrane Database Syst Rev. 2011 Nov 9;(11):CD008007. 78. US Department of Agriculture. Agricultural Research Service. Nutrient Data Laboratory. USDA National Nutrient Database for Standard Reference, Legacy. Version Current: April 2018. https​://nd​b.nal​.usda​.gov/​ndb/n​utrie​ nts/r​eport​/nutr​ients​f rm?m​a x=25​&offs​et=0&​totCo​u nt=0​& nutr​ient1​=213&​ nutri​ent2=​&subs​et=0&​sort=​c&mea​sureb​y=m. Accessed August 6, 2018. 79. US Department of Agriculture. Agricultural Research Service. Nutrient Data Laboratory. USDA National Nutrient Database for Standard Reference, Legacy. Version Current: April 2018. www.a​rs.us​da.go​v/nor​theas​t-are​a/ bel​tsvil​le-md​-bhnr​c/bel​tsvil​le-hu ​man-n​utrit ​ion-r​esear​c h-ce​nter/​nutri​entd​ata-l​abora​tory/​docs/​u sda-​natio​nal-n​utrie​nt-da​tabas​e-for​-stan​dard-​refer​ ence/​. 80. Centrum Products. Centrum Silver 50 Plus. Lutein + xeaxanthin. www. c​entru​m.com​/cent​rum-s​ilver​-wome​n-50-​plus. Accessed June 30, 2018. 81. US Department of Agriculture. Agricultural Research Service. Nutrient Data Laboratory. USDA National Nutrient Database for Standard Reference, Legacy. Version Current: April 2018. www.a​rs.us​da.go​v/nor​theas​t-are​a/ bel​tsvil​le-md​-bhnr​c/bel​tsvil​le-hu ​man-n​utrit ​ion-r​esear​c h-ce​nter/​nutri​entd​ata-l​abora​tory/​docs/​u sda-​natio​nal-n​utrie​nt-da​tabas​e-for​-stan​dard-​refer​ ence/​.

L

M Magnesium Definition Fourth most predominant body mineral and second most abundant intracellular cation that performs roles including participating in energy metabolism, vitamin D metabolism and action, protein synthesis, immunity, carbohydrate metabolism, blood glucose and blood pressure (BP) regulation, and the transport of calcium and potassium ions into cells necessary for nerve impulse conduction, muscle contraction, and normal heart rhythm.1–5 Magnesium (Mg) regulates parathyroid hormone function that is critical for bone mineralization.5,6 Most Mg is found in bone and the rest is in soft tissue.3 Mg is withdrawn from bone to maintain blood levels when dietary intake is inadequate.7 Mg is generally an under-consumed “nutrient of concern:” men aged 71 years + and adolescent females are most likely to have low intakes.8,9 Mg is one of three minerals, along with potassium and calcium, supplied by vegetables, dairy foods, whole grains, and protein group foods that contribute to the BP-lowering effect of the Dietary Approaches to Stop Hypertension (HTN) or the DASH Diet that has been shown to significantly lower BP in patients with stage 1 HTN, high-normal BP, and BP in isolated systolic HTN (Table M.1).10 Mineral-rich “hard” water is a source of Mg. American men may fulfill 6% to 23% and women 8% to 31% of their Mg RDA by drinking 2 L of tap water, though water mineral content varies widely among and within municipalities;5 another estimate is that approximately 10% of the daily Mg requirement is derived from drinking water.5 Mg deficiency can be caused by inadequate intake; vomiting; diarrhea/malabsorption; increased urinary Mg excretion, for example, by uncontrolled diabetes or renal dysfunction; alcohol abuse; protein malnutrition; prolonged nutritionally inadequate intravenous fluid use; use of diuretic medications; and a wide range of inherited and acquired diseases.2,3,5,11 Mg deficiency can initially result in muscle cramps, HTN, coronary and cerebral vasospasms, loss of appetite, nausea, vomiting, fatigue, and weakness; and as Mg deficiency worsens, numbness, tingling, muscle contractions and cramps, seizures, sudden changes in behavior, personality changes, abnormal heart rhythm, and coronary spasms can occur.2 Mg deficiency causes bone demineralization in all age groups,6 abnormal bone growth, 201

M

M

202

Magnesium Table M.1  Common Food Sources of Mg 10–19% DV = good sources; > 20% DV = excellent sources of Mg61

Dark Green Leafy Vegetables and Legumes Spinach, cooked, 1 c (157 mg, 37% DV) Black beans, 1 cup (120 mg, 28.5% DV) Edamame, ½ cup, frozen (36 mg, 8.5% DV) Spinach, raw 1 cup (24 mg, 6% DV) Naked® Green Machine Juice Smoothie, 10 oz (42 mg, 10% DV) Whole Grains Oats, 1 cup (276 mg, 65% DV) Chia seeds, 1 oz (95 mg, 23% DV) Multigrain bagel, 1 (69 mg, 16% DV) Dairy Foods Soymilk, unflavored, 1 cup (61 mg, 14.5% DV) 2% Milk, regular (37 mg, 8% DV) Protein Group Foods Almonds, ¼ cup, salted and dry-roasted (96 mg, 22% DV) Tempeh, 1 cup (134 mg, 32% DV) Salmon, 3 oz, baked (104 mg, 25% DV) Peanut butter, 2 tablespoons (57 mg, 13% DV) Cocoa Products Cocoa, dry powder, unsweetened, 1 tablespoon (26 mg, 6% DV) Semisweet chocolate chips, ½ cup (96 mg, 22% DV) Ovaltine, chocolate malt powder, 3 tablespoons (30 mg, 7% DV)

and skeletal weakness.12 “Normal serum [Mg] concentrations range between 0.75 and 0.95 mmol/L; however, serum levels have little correlation with total body Mg levels or concentrations in specific tissues. To comprehensively evaluate [Mg] status, both laboratory tests and a clinical assessment might be required.”3

Scientific Findings Hard water consumption is associated with decreased arterial BP.13 Epidemiologic, observational, and clinical trial data generally show that a diet high in Mg (at least 500–1000 mg/day) may reduce blood pressure as much as 5.6/2.8 mm Hg, but clinical trials have shown a wide range of BP reduction, with some showing no change in BP.10 Most epidemiology demonstrates an inverse relationship between dietary Mg intake and BP.4,10 A meta-analysis of 12 RCTs (n = 545 subjects with HTN) with 8 to 26 weeks follow-up found that participants receiving Mg supplements compared to controls had statistically significantly reduced diastolic, but not systolic, BP.14

Mango (Mangifera indica)

203

Increased intake of Mg and potassium together with reduced sodium intake is more effective at reducing BP than either intake of Mg or potassium alone,10 “Reducing intracellular sodium and calcium while increasing intracellular Mg and potassium improves BP response.”14 “[Mg] acts as a natural calcium channel blocker, increases nitric oxide, improves endothelial dysfunction, and induces direct and indirect vasodilation.”10 Mg intake, but not calcium intake, was significantly associated with total body bone mineral content and bone mineral density (BMD) according to the findings of a small clinical trial (n = 50 children aged 4–8). Mg deficiency may be associated with the development of insulin resistance and hyperglycemia.15 A meta-analysis of seven cohort studies (n = 286,668 participants) found an inverse relationship between Mg intake and risk of Type II diabetes in all but one study, and in four studies the association was statistically significant: 100 mg Mg/day reduced the risk of Type II diabetes by 15%.16 Higher dietary intakes of Mg have been associated with a decreased risk of metabolic syndrome.17

Bioactive Dose The RDA for Mg for adult women aged 31–50 is 320 mg and for men aged 31–50 is 420 mg.

Safety When ingested as a naturally occurring substance in foods, Mg has not been associated with any adverse events (AEs).2 Total Mg intake from non-food sources such as dietary supplements and Mg-containing medications should not exceed 350 mg/day for adults; 350 mg/day is the Mg UL. Note the narrow margin between the RDA of 320 mg/day and the UL of 350 mg/day. Excess Mg from non-food sources is associated with AEs such as diarrhea.2

Mango (Mangifera indica) Definition Juicy, orange-fleshed tropical fruit eaten fresh or dried, that is an excellent source of vitamin A (893 IU, 29% DV) and supplies polyphenols, terpenoids, steroids, phenolics, and flavan-3-ols.18

Scientific Findings In in vitro and in vivo models, mango has exerted antioxidant, iron chelator, anti-inflammatory, antinociceptive, antitumor, and immunomodulatory

M

204

Marjoram, sweet (Origanum majorana)

properties.18–20 Raw M. indica fruit killed aerobic and anaerobic acneinducing bacteria and was anti-inflammatory in skin cells.21 See also: Phenolics and Flavonoids.

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Marjoram, sweet (Origanum majorana)

M

Definition Mint family herb that contains phenolics and terpenoids.22 It is used fresh or dried to complement carrots, mushrooms, peas, zucchini, tomatoes, eggs, chicken, duck, halibut, tuna, and lamb.23 Marjoram has been used for rhinitis and colds in infants and toddlers; gastritis; stimulating appetite; aiding digestion; to promote circulation and healthy sleep; to treat mood swings; and as an astringent, antispasmodic, and antiflatulent.24

Mediterranean Diet

205

Scientific Findings Marjoram essential oils exhibited antimicrobial and antifungal properties in laboratory studies.25,26

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Mediterranean Diet Definition Traditional dietary style of the Mediterranean basin that is associated with cardiovascular and cognitive health.27 It includes large amounts of olive oil, vegetables and leafy greens, fruit, whole grains, nuts, legumes, moderate amounts of fish, meat, dairy products, and red wine, and is low in eggs and sweets. It is high in unsaturated fat and polyphenolic compounds, such as flavonoids and phytosterols from red wine, olive oil, coffee, tea, nuts, fruits, vegetables, herbs, and spices.27

Scientific Findings A meta-analysis of 11 randomized controlled trials (RCTs) of healthy adults at high risk of cardiovascular disease (CVD) (n = 52,044) found limited but favorable evidence of Mediterranean dietary patterns on CVD risk factors.28 The PREDIMED prospective cohort study (n = 7122 participants aged 55–80 years at high risk for CVD) found reductions in CVD-related mortality due to following a Mediterranean Diet.29,30 A meta-analysis (n => 4.7 million people) found reduced mortality, CVD-related mortality, and a reduced risk of Parkinson’s and Alzheimer’s disease related to following a Mediterranean Diet-style eating pattern (Table M.2).30

M

M

206

Melatonin

Bioactive Dose Table M.2  Mediterranean Diet Vegetables Fruit Bread and cereals Legumes Nuts Fish/Seafood Eggs Poultry Dairy foods Red meat Sweets Red wine

>2 servings/meal (“high consumption”) 1–2 servings/meal (“high consumption”) 1–2 servings/meal (“high consumption”) >2 Servings/week (“high consumption”) 1–2 Servings/daily >2 Servings/week 2–4 Servings/week 2 Servings/week 2 Servings/day (“moderate consumption”)  910 µg”30 —quantities that would most likely occur due to dietary supplementation and not food intake of Se. In two large clinical trials examining Se supplementation and prostate cancer development, Se supplementation of 200 μg of Se daily for 7.7 years reduced prostate cancer development but participants in the top tertile of plasma Se had a higher risk of developing Type II diabetes, while Se had no effect on prostate cancer development in the second study and higher risk of newly diagnosed Type II diabetes mellitus.22

Shallot (Allium cepa L. var. aggregatum)

309

Shallot (Allium cepa L. var. aggregatum)

Definition Miniature purple onion that contains allyl sulfides and flavonol glycosides, including quercetin.31 Used for their strong, characteristically burning flavor in salads and salad dressings.

Scientific Findings See Allium vegetables and Quercetin.

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

S

310

Snap Pea and Snow Pea

Snap Pea (Pisum sativum L.) and Snow Pea (Pisum sativum var. macrocarpon, Pisum sativum var. saccharatum)

S Definition Fabaceae green pod vegetables containing edible legumes. The snap pea (also called sugar snap pea32 and green pea33) may be stir-fried or otherwise cooked and is available as a baked, salted, ready-to-eat snack. Fresh shoots of the snap pea are used as microgreens, i.e., young sprouts or “pea shoots,” in salads or as a garnish, and dried, split peas are an excellent source of choline (153 mg, 28% DV) per ½ cup34 in addition to many other nutrients (see also: Legume). The snap pea is plump with slightly tough skin. Snap peas contain fiber (2 g, 7% DV) and are an excellent source of vitamin C (36 mg,

Sodium

311

40% DV), while also supplying phenolic compounds and flavonoids.35,36 The snow pea is flat and tender. It is eaten fresh or steamed, usually after the tough strings along the edges are removed.32 The snow pea supplies 2 g of fiber (7% DV) and is a good source of vitamin C (15 mg, 16% DV) per 3 oz.37 Sativin isolated from snow pea (Pisum sativum var. macrocarpon) exerted antifungal activity in vitro against a variety of organisms.38

Scientific Findings In an animal study, diets containing P. sativum reduced serum total cholesterol, LDL, VLDL, and cholesterol-to-HDL ratio.39 See also: Legume.

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Sodium Definition Major mineral electrolyte and primary intracellular cation that is necessary for maintaining fluid balance, blood volume, blood pressure, nerve impulse transmission, acid-base balance, muscle function, and plays many other vital roles.40 Typical dietary intake: Sodium is a common food additive, abundant in processed, ready-to-eat foods; table salt is a combination of sodium and chloride and the most common source of dietary sodium in the American diet. Most people in the US get more sodium in their diets than they need, while sodium deficiency is unlikely. Acute sodium deficiency and excess can occur due to illness or extreme conditions. Deficiency may occur in cases of fluid loss such as vomiting, diarrhea, blood loss, sweating, excessive urination, and use of certain medications, such as diuretics. Sodium deficiency causes disturbances in acid-base balance, poor appetite, muscle cramps, confusion, apathy, constipation, and cardiac arrhythmia,40 Sodium excess is associated with hypertension.41

Scientific Findings A review of 257 randomized and nonrandomized controlled trials and observational studies found that “interventions that reduce sodium intake (including those that use potassium-containing salt substitutes in

S

S

312

Soybean (Glycine max)

the diet) reduce blood pressure in normotensive adults and, to a greater extent, in those with hypertension. Prospective cohort studies show that higher sodium intakes may be associated with greater risk for hypertension and CVD, CHD, and stroke morbidity, and mortality.42 The Dietary Guidelines 2015–2020 recommends consuming a Healthy Eating Pattern that limits sodium.43

Bioactive Dose The AI for sodium for adults aged 19–50 is 1,500 mg.

Safety The UL for sodium for adults aged 19–50 is 2,300 mg.

Soybean (Glycine max) Definition Fabaceae vegetable that contains protein which is similar, but not equal, to animal protein, and is a source of isoflavones—see also: Isoflavones.44 Edamame are immature soybeans that are good sources of fiber (5.2 g fiber, 17% DV) and zinc (1.25 mg, 11% DV), and excellent sources of vitamin C (37 mg, 41% DV), calcium (250 mg, 19% DV), potassium (793 mg, 23% DV), iron (4.5 mg, 25% DV), and folate (211 µg, 52% DV) per ½ cup.45 Tofu, tempeh, miso, natto, soy milk, and soy-based infant formula also are commonly used in vegetarian diets as protein substitutes, but they lack vitamin B12 unless their ingredients state that it has been added. Soybean oil, an omega-6 polyunsaturated fatty acid, supplies 23 mg of β-sitosterol per tablespoon.46,47

Scientific Findings Some evidence suggests soy protein added to a diet low in saturated fat reduces the risk of coronary heart disease, but there are inconsistent findings concerning the ability of soy protein to lower LDL cholesterol.48,49 A review of 13 studies found conflicting evidence on the effect of increased soy food intake and blood pressure.50 See also: Isoflavones.

Bioactive Dose Not known. The dose of soy protein needed to achieve significant decreases in total or LDL cholesterol or triglycerides has not been established,50 but a dose of 20 (approximately ⅔ cups of cooked edamame)–50 g (approximately 1.5 cups of cooked edamame)51 of soy protein daily was used in for hyperlipidemia in clinical trials.14

Spinach (Spinacia oleracea)

313

A healthy eating pattern based on a 2,000-calorie level should include: • 3 c-equivalent/day of fat-free or low-fat dairy, including milk, yogurt, cheese, and/or fortified soy beverages (commonly known as soymilk) • 5½ oz-equivalent/day of a variety of protein foods, including seafood, lean meats and poultry, eggs, legumes (beans and peas), and nuts, seeds, and soy products.43

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals. Allergies to soybean have been reported. “A systematic review and meta-analysis that included 15 placebo-controlled treatment groups and an additional 32 reports involving 36 treatment groups found no effects of soy protein or isoflavone intake on testosterone, sex hormone binding globulin, free testosterone or the free androgen index,” though two cases of male feminization have been reported that involved men ingesting 360 mg isoflavones a day;44 as 8 oz cup of low-fat soymilk contains 25 mg of isoflavones,52 14 8 oz glasses of low-fat soymilk would be required to ingest 360 mg of isoflavones.

Spinach (Spinacia oleracea) Definition Dark green leaf vegetable that is a good source of folate (58 µg, 14.5% DV) and an excellent source of vitamins A (2,813 IU, 94%) and K (144 µg, 120% DV) per 1 cup.53 Spinach supplies lutein, 54 saponin, and oxalate (the phytochemical that gives raw spinach its distinctive “mouth feel” described as a film in the mouth). Unlike other dark green vegetables, spinach is a poor calcium source, providing only 30 mg per 1 cup (2% DV). Despite its high-iron reputation, spinach is only a fair source of iron, providing approximately 0.8 mg of nonheme iron per 1 cup (4% DV)55 depending on the brand (some brands may contain slightly more), whereas a “good source” would supply 10–19% DV. Spinach is high-iron vegetables, than many vegetables (e.g., 1 cup of green onions supplies 0.48 mg and 2.6% DV and watercress has 0.7 mg and 0.3% DV of iron), 56 whereas legumes are high-iron vegetables, supplying up to 10 mg per cup (55% DV of iron).57 Baby spinach salad, the Greek dish spanakopita (literally meaning “spinach with bread”), and sautéed spinach are some typical uses of spinach.

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Squash (Curcubito pepo)

Scientific findings Consumption of green leafy vegetables is associated with a reduced risk of several types of cancer such as pancreatic cancer, and cardiovascular disease.58,59 High intake of green leafy vegetables was linked to a reduced risk of non-Hodgkin lymphoma in a population-based case-control study (n = 348 cases and 470 controls) that compared dietary intake of cases to controls.60 A randomized, controlled, crossover trial (n = 30 healthy men and women) found that flavonoid-rich apples and nitrate-rich spinach independently augmented nitric oxide status, enhanced endothelial function, and lowered blood pressure acutely.61

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Squash (Curcubito pepo) Definition Cultivar that yields immature fruits (summer squash) and mature fruits (winter squash), pepo being the Latin word for fruit.62 Squash is high in starch (15 g per ½ cup), rich in vitamin A (400 IU, 13% DV), and a source of all B vitamins except vitamin B12.63 Summer squash has a thin, edible skin and includes yellow squash (Cucurbita pepo L.), zucchini (Cucurbita pepo), and patty pan squash (Cucurbita pepo var. ovifera). Yellow- or orange-fleshed spaghetti (Cucurbita pepo L., Cucurbitaceae), acorn (Cucurbita pepo ssp. ovifera), butternut (Cucurbita moschata), and Hubbard squash (Curcubita maxima), is carotenoid-rich and therefore a good source of vitamin A and a significant source of starch (15 g per) per ½ cup. The Cucurbita species are of American origin.64 Winter squash’s hard skin increases its storage life: it can be stored for up to 3 months in cool temperatures. Winter squash is prepared by baking in the shell or by removing the shell and then baking and mashing the flesh. Prehistoric cultures could have used these species primarily as containers or for their seeds, which are edible and nutritious.62

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Scientific Findings Greater intake of yellow/orange vegetables was one of several dietary patterns that were associated with significantly lower breast cancer risk in a 30-year observational study (n = 182,145 women initially aged 27–59 years in the Nurses’ Health Study).65

Bioactive Dose Not known. Adult women and men aged 19–50 require 2.5 cups or 3 cups of vegetables, per day, respectively, ideally including all subgroups, including dark orange vegetables.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Stanols, sterols Definition Steroid compounds, such as sitostanol, campestanol, sitosterol, campesterol, and stigmasterol have chemical structures similar to cholesterol66 and prevent cholesterol absorption which in turn helps to lower serum LDL cholesterol by an average of 6% and as much as 14% in four weeks.67 Found naturally in fruits, grains, vegetables and vegetable oils, nuts and seeds, wheat germ and wheat bran; peanuts; corn, sesame, canola, and olive oil; almonds; and Brussels sprouts,67 these compounds are underconsumed. Normal dietary intake of plant sterols is 200–400 mg/day, a level that would not significantly affect cholesterol absorption, but when consumed at levels 5–10 times higher than normal, they have been shown to reduce total and LDL cholesterol.”68 Vegetable-oil-based, steroidenriched spreads, mayonnaise, yogurt, milk, orange juice, cereals, and snack bars that have been fortified with plant sterols and stanols are commercially available.23

Scientific Findings Including plant sterol/stanol esters in the diet helps to lower blood total and LDL cholesterol levels.69 A meta-analysis that included 14 studies (n = 531 patients) showed that there is no statistically or clinically significant difference between plant sterols and plant stanols in their abilities to modify serum total cholesterol.66

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Starchy Vegetables Table S.1  Phytosterol Content of Common Foods Totaling 3 g

Food, quantity Olive oil, 3 tablespooons 1 sesame bagel (containing 1 tablespoon sesame seeds) Cashew nuts, dry-roasted with salt, 4 tablespoon (approx ¼ cup) Snacks, vegetable chips, made from garden vegetables, 1 cup Banana, 1 medium Cauliflower, 1 cup Total

mg of phytosterol 90 64 57 43 36 19 309

Source: 82

Bioactive Dose The National Heart Lung and Blood Institute’s National Cholesterol Education Program Therapeutic Lifestyle Changes recommends individuals with elevated LDL cholesterol consume 2 g of plant sterols/stanols per day.70 “A reduction of up to 10% total cholesterol is observed when 2–3 g of plant stanol/sterol esters are consumed daily (Table S.1).”30

Safety An intake of 2–3 g of plant sterols and stanols per day generally appears to be safe.71 “It is unclear whether there are unintended AEs when consuming sterols. Some studies have detected no significant changes in the plasma concentrations of alpha-carotene, lycopene, and vitamins A, D, and E; however, other studies have found that the plasma concentrations of alpha-tocopherol and alpha- and β-carotene decrease after the consumption of sterols and stanols.”72 Preliminary research suggests that consuming one extra carotenoid-rich fruit or vegetable per day has been shown to maintain plasma carotenoid levels when also consuming sterolenriched spreads.73

Starchy Vegetables Definition Vegetables that generally have a higher carbohydrate content (~15 g of carbohydrate per ½–1 cup serving) than non-starchy vegetables, such as lettuce and tomatoes (~5 g of carbohydrate per ½–1 cup serving), and therefore are considered to be equivalent to grains for diet planning purposes.74 Parsnips, winter squash, white potatoes, sweet potatoes, yams, plantains, and legumes are starchy vegetables.

Strawberry (Fragaria x ananassa)

317

Scientific Findings Starch is the major glycemic carbohydrate, along with sugars, in foods. Starchy vegetables increase serum glucose.75 However, some starchy vegetables contain resistant starches that either reduce or have no effect upon glycemic load in addition to having other health benefits—see also: Fructan.76

Bioactive Dose Not applicable.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Strawberry (Fragaria x ananassa) Definition Berry that is a source of fiber (2.3 g, 8% DV), potassium (177 mg, 5% DV) folate (28 µg, 7% DV), and an excellent source of vitamin C (68 mg, 75% DV).77 Eaten fresh, frozen, dried, and added to juice, cereals, desserts, and baked products.

Scientific Findings Strawberry constituents ameliorated allergy symptoms in a laboratory study.78 “Strawberry phenolics are best known for their antioxidant and anti-inflammatory action, and possess direct and indirect antimicrobial, anti-allergy and antihypertensive properties, as well as the capacity to inhibit the activities of some physiological enzymes and receptor properties.”79 Ellagic acid, a phenolic compound in strawberries, acid reduced oxidative stress in laboratory studies.80,81

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals. Allergy to strawberries has been reported.

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References

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71. The Academy of Nutrition and Dietetics Evidence Analysis Library. Diseases/health conditions. Disorders of lipid metabolism. 2005. Plant sterols/stanols sterols and stanols. What does the research indicate about the safety of stanol and sterol intake? Accessed January 10, 2012. 72. The Academy of Nutrition and Dietetics Evidence Analysis Library. Diseases/health conditions. Disorders of lipid metabolism. 2005. Plant sterols/stanols sterols and stanols. 2005 Are there any unintended adverse effects when consuming stanols and sterols? http:​//and​evide​ nceli​brary​.com/​concl​u sion​.cfm?​concl​u sion​_ stat​ement​_ id=5​2. Accessed August 1, 2013. 73. Academy of Nutrition and Dietetics Evidence Analysis Library. Disorders of lipid metabolism. 2005. Plant sterols/stanols sterols and stanols. How might the consumption of carotenoid-rich fruits or vegetables alter plasma carotenoid levels when also consuming sterols? http:​//and​evide​nceli​brary​.com/​ concl​usion​.cfm?​concl​usion​_ stat​ement​_id=5​2. Accessed August 1, 2013. 74. The American Diabetes Association. Whole grain foods. www.d​iabet​es.or​g /foo​d-and​-fitn​e ss/f​o od/w​h at-c​a n-i-​eat/g​rains​-and-​starc​hy-ve​getab​les.h​ tml. Accessed August 1, 2013. 75. Dauchet L, Amouyel P, Dallongeville J. Fruit and vegetable consumption and risk of stroke: A meta-analysis of cohort studies. Neurology. 2005;65(8):1193–1197. 76. Grabitske HA, Slavin JL. Gastrointestinal effects of low-digestible carbohydrates. Crit Rev Food Sci Nutr. 2009;49(4):327–360. 77. US Department of Agriculture. Agricultural Research Service. Nutrient Data Laboratory. Strawberries, raw. http:​//ndb​.nal.​usda.​gov/n​db/fo​ods/s​ how/2​401?f​g=&ma​n=&lf​acet=​&coun​t=&ma​x=25&​qlook​up=st​rawbe​r ry& o​ffset​=&sor​t=&fo​r mat=​Abrid​ged&_​actio​n _sho​w=App​ly+Ch​a nges​&Qv=1​ &Q448​4 =1.0​&Q448​5 =0.5​&Q448​6 =1.0​&Q448​7=1.0​&Q448​8 =1.0​&Q448​9=1.0​ &Q449​0=1.0​&Q449​1=1.0​&Q449​2=1.0​&Q449​3=1.0​. Accessed July 29, 2013. 78. Itoh T, Ninomiya M, Yasuda M, Koshikawa K, Deyashiki Y, Nozawa Y, Akao Y, Koketsu M. Inhibitory effects of flavonoids isolated from Fragaria ananassa Duch on IgE-mediated degranulation in rat basophilic leukemia RBL-2H3. Bioorg Med Chem. 2009;17(15):5374–5379. 79. Giampieri F, Alvarez-Suarez JM, Mazzoni L, Romandini S, Bompadre S, Diamanti J, Capocasa F, et al. The potential impact of strawberry on human health. Nat Prod Res. 2013;27(4–5):448–455. 80. Kannan MM, Quine SD. Ellagic acid ameliorates isoproterenol induced oxidative stress: evidence from electrocardiological, biochemical and histological study. Eur J Pharmacol. 2011 Mar 5;659(1):45–52. 81. Uzar E, Alp H, Cevik MU, Fırat U, Evliyaoglu O, Tufek A, Altun Y. Ellagic acid attenuates oxidative stress on brain and sciatic nerve and improves histopathology of brain in streptozotocin-induced diabetic rats. Neurol Sci. 2011 Sep 16;33(3):567–574. 82. US Department of Agriculture. Agricultural Research Service. Nutrient Data Laboratory. USDA National Nutrient Database for Standard Reference, Legacy. Version Current: April 2018. https​://nd​b.nal​.usda​.gov/​ndb/n​utrie​ nts/r​eport​?nutr​ient1​= 636&​nutri​ent2=​& nutr​ient3​=&&ma​x=25&​subse​t=0& o​ffset​=75&s​ort=c​&totC​ount=​483&m​easur​eby=m​.

S

T Tamarind (Tamarindus indica)

Definition Pod-shaped Leguminosae family fruit that is indigenous to tropical Africa1 but is also grown commercially in Florida.2 Tamarind is a good source of potassium (377 mg, 11% DV)3 that contains large amounts of the phytochemical tartaric acid.4 The beanlike fruit is made into a sweet sauce used in Asian and Indian cuisine and tamarind-flavored carbonated beverages and salad dressings.4 Tamarind has been used in traditional African medicine as a laxative, for abdominal pain, to treat diarrhea and dysentery, to treat helminth infections, for wound healing, and to treat malaria, and for fever, constipation, inflammation, cell cytotoxicity, gonorrhea, and eye diseases.5,6

Scientific Findings Tamarindus indica seeds exhibited antioxidant properties and Tamarindus indica extract exhibited antidiabetic properties in laboratory research.7,8 Tartaric acid may be beneficial for digestion and bowel regulation.9

Bioactive Dose Not known. 325

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326

Tannin

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Tangerine (Citrus reticulata) Definition Citrus genus fruit that is similar, but smaller than, the navel orange. Usually eaten fresh or consumed as juice. A large (2¾-inch diameter) tangerine supplies 199 mg (6% DV) of potassium, 19 µg (5% DV) of folate, is an excellent source of vitamin C (32 mg, 35% DV), and contains an array of flavonoids (flavones, flavonols, and flavanones, such as kaempferol). Both canned tangerine (mandarin oranges) and fresh tangerines are a significant source of the antioxidant beta-cryptoxanthin, one of five carotenoids that predominate in human plasma.10–13

Scientific Findings In a laboratory study, beta-cryptoxanthin exhibited antitumor effects.14 Kaempferol and some of its glycosides have a wide range of beneficial pharmacological activities, including analgesic, antiallergic, anticancer, antidiabetic, anti-inflammatory, antimicrobial, antiosteoporotic, antioxidant, antiapoptotic, anxiolytic, cardioprotective, estrogenic/antiestrogenic, and neuroprotective.15,16 See also: Citrus.

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Tannin Definition Secondary plant metabolite classified as a proanthocyanidin.17 Found in many foods including black-eyed peas, grapes, lentils, persimmon, black and green teas, coffee, and red and white wines.18,19 Tannins contribute color, bitterness, and astringency, for example, of wine.20

Tarragon (Artemisia dracunculus)

327

Scientific Findings In in vitro studies, tannins exhibited chemoprotective properties18 and bound bile acids.19 Tannins can form insoluble complexes with carbohydrates and protein; their concomitant ingestion with nonheme iron inhibits nonheme iron absorption21,22 and can significantly impact iron status.23 Consuming vitamin C improves nonheme iron absorption and nullifies tannins’ opposite effects.

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Tarragon (Artemisia dracunculus) Definition Culinary herb used fresh or dried in cooking. Its flavor has been described as “strong and tangy with lingering lemon, anise, and basil undertones and a sweet aftertaste.”24 Tarragon complements chicken and fish and can be used to flavor salad dressings and vegetables. It has been used in traditional folk medicine to treat pain and gastrointestinal disturbances;25 and in Iranian folkloric medicine, tarragon has been used orally as an antiepileptic remedy.26

Scientific Findings In vitro, tarragon exhibited antioxidant and antinociceptive properties27, 25 and induced potent anticancer effects, including inhibiting esophageal squamous cell carcinoma.28 Tarragon exhibited antiseizure and sedative effects that were attributed to its monoterpenoids content in laboratory research.26

Bioactive Dose Not known.

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328

Tea (Camellia sinensis)

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Tea (Camellia sinensis) Definition One of the most ancient and popular beverages consumed around the world, second only to water, 29,30 that is prepared by steeping Camellia sinensis leaves in water. Consumed hot, iced, and sweetened or unsweetened. “After harvesting, tea leaves begin to oxidize … Black tea is produced when tea leaves are … fully oxidized. … Green tea is made from … leaves that are not oxidized. Oolong tea is made from … partially oxidized leaves, creating an intermediate kind of tea. White tea is made from young leaves or growth buds that have undergone minimal oxidation.”29 Traditionally consumed for its mild central nervous system stimulating effects, all tea contains caffeine. Per 8 oz, brewed green tea contains approximately 29 mg of caffeine31 and black tea contains 36 mg of caffeine, 32 depending on how long the tea is steeped (stronger tea would contain more caffeine). Tea phytochemicals include alkaloids (caffeine, theophylline, and theobromine), chlorophyll, flavon-3-ols, including catechins, and trace elements, such as fluoride.29 Green tea is particularly rich in catechins which are the substances most associated with health benefits.

Scientific Findings Laboratory studies have shown that “tea catechins act as powerful inhibitors of cancer growth in several ways: they scavenge oxidants before cell injuries occur, reduce the incidence and size of chemically induced tumors, and inhibit the growth of tumor cells. In studies of liver, skin, and stomach cancer, chemically induced tumors were shown to decrease in size in mice that were fed green and black tea.”29 Some epidemiological studies comparing tea drinkers to non-tea drinkers support the claim that drinking tea prevents cancer; others do not. A 12-year prospective cohort study (n = 18,244 men aged 45–64 years compared with 772 control subjects) found that tea drinkers were about half as likely to develop stomach or esophageal cancer as men who drank little tea; whereas, no link was found between black tea consumption and the subsequent risk of stomach, colorectal, lung, and breast cancers in a 4.3-year prospective cohort study (n = 58,279 men, n = 62,573 women aged 55–69).33 Though “There is insufficient and conflicting evidence to give any firm recommendations

Terpenoids

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regarding green tea consumption for cancer prevention,” according to a meta-analysis of 51 studies (n=>1.6 million participants) that observed 3 to 5 cups per day (up to 1200 ml/day), providing a minimum of 250 mg/day of catechins may be a “desirable” amount.34

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals. Aluminum (Al), a neurotoxic element, is found in green and black tea, because the tea plant naturally takes up Al from soil, in levels of 14 to 27 µg per liter (μg/L) to 431 to 2239 μg/L, though it is not clear how much Al is bioavailable, and there is no evidence of Al toxicity associated with drinking tea.35

Terpenoids Definition Group of phytochemicals whose main subclasses are monoterpenes (including limonene, carvone, and carveol); diterpenes (including the retinoids); triterpenes (such as saponins); tetraterpenes (e.g., carotenoids, including carotenes and xanthophylls), triterpenoids (e.g., glycosides), and steroids (including stanols, sterols, and tocopherols). Terpenoids occur in nearly every natural food,36 and, along with other phytochemical constituents in foods, impart sensory qualities, for example, the characteristic ‘”green’, ‘woody’, ‘earthy’, ‘fruity’, ‘floral’, ‘sweet’ and ‘musty’” flavor of pomegranate.37 Specific examples of foods that contain terpenoids include citrus fruits, coriander, lemongrass, caraway, peppermint, rosemary, sage, and thyme.38

Scientific Findings Terpenoids exhibited antimicrobial effects in a laboratory study.25 Cancer prevention advice to eat at least 2.5 cups of vegetables and fruits each day is based on plant foods’ “numerous potentially beneficial bioactive substances, such as terpenes … that may help prevent cancer.”39

Bioactive Dose Not known.

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330

Thiamin (vitamin B1)

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Thiamin (vitamin B1) Definition Water-soluble vitamin necessary for glucose, alcohol, and branch chain amino acid metabolism; to synthesize RNA; and for neuronal activities, including to synthesize neurotransmitters, such as acetylcholine.40–42 Thiamin is found in whole, fortified, and enriched grains, legumes, pork, and sunflower seeds;41 breads, ready-to-eat cereals, and mixed foods whose main ingredient is grain are major thiamin contributors in the US diet.40 The average US diet contains adequate thiamin,40 but thiamin deficiency occurs due to insufficient ingestion (e.g., in those who consume limited food, including alcoholics, the malnourished, and the homeless); heightened requirements (e.g., in pregnancy, lactation, adolescence, postsurgery, infection, fever, and alcohol dependency); and loss (e.g., when it is excreted in high amounts as with the use of certain medications, such as loop diuretics, malabsorption, and/or persistent vomiting/hyperemesis gravidarum.41,43,44 Thiamin deficiency is mistakenly thought to be confined to alcoholism. The inability of brain and nerve tissue to produce energy from glucose rapidly affects nervous system function and reduces neurotransmitter synthesis: early symptoms include depression and muscle weakness after only about 10 days on a thiamin-free diet.41 Neurological deficits related to thiamin deficiency, or “dry beriberi,” may include anorexia, weight loss, mental status changes, apathy, decreases in short-term memory, confusion, irritability, poor coordination, tingling in the arms and legs, peripheral neuropathy, delirium, structural and functional brain injury, and paralysis. Cardiovascular manifestations of thiamin deficiency, or “wet beriberi,” may include: enlarged heart, rapid heartbeat, pedal edema, anasarca, and/or other severe cardiac abnormalities; in addition, renal failure has been reported.40,45–49 Thiamin deficiency is prevalent in congestive heart failure (CHF) patients.43 Thiamin deficiency is erroneously assumed to be associated only with alcoholism.50 Wernicke encephalopathy, the neuropsychiatric syndrome characterized by mental status changes (e.g., short-term memory loss, disorientation, and confabulation [confusion between real and imagined memories]), ocular dysfunction, and gait ataxia,50,51 and Korsakoff syndrome (also called Korsakoff psychosis or Wernicke-Korsakoff syndrome), the permanent damage to areas of the brain involved with memory, are conditions

Thyme (Thymus vulgaris)

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caused by acute and chronic thiamin deficiency, respectively.52,53 A case of Wernicke encephalopathy with symptoms of weakness, areflexia, followed by confusion, ophthalmoplegia, and nystagmus has been reported following bariatric surgery,48 and thiamin deficiency was found to be common in post-surgical sleeve gastrectomy patients (n = 147).54 “Thiamin deficiency should always be considered in cases with acute or subacute amnesia.”55 Several foods, such as tea, coffee, blueberries, and red cabbage, contain antithiamin factors that cannot be inactivated by cooking, whereas, antithiamin factors in raw shellfish and raw freshwater fish are destroyed by cooking.41 Thiamin status can be assessed by in vitro erythrocyte transketolase activity assay.40,56 Thiamin status has also been measured using erythrocyte levels of thiamin diphosphate.57

Scientific Findings A high dietary intake of thiamin was associated with a reduced risk of lens opacification in a 5-year study (n = 408 women from the Nurses’ Health Study aged 52–74 years at baseline) evaluating nutrition and vision.58 Higher intake of thiamin was associated with reduced prevalence of nuclear cataract in a population-based study (n = 2,900 healthy people aged 49–97 years).59 Compared with placebo, thiamin supplementation resulted in a significantly improved net change in left ventricular ejection fraction in CHF patients on diuretic therapy (n = 38 patients in two randomized, double-blind, placebo-controlled trials).43 Administering glucose to thiamin-deficient patients has been associated with the development of Wernicke encephalopathy.60

Bioactive Dose The RDA is 1.2 mg for men aged 19–50 and 1.1 mg for women aged 19–50.

Safety No UL has been established for thiamin. Thiamin is generally regarded as non-toxic.

Thyme (Thymus vulgaris) Definition Culinary herb that contains phenolics, flavonoids, and terpenoids.61 Used fresh or dried to flavor beef, chicken, fish, lamb, pork, and venison,62 and tomato-based soups such as seafood chowder.

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Tofu

Scientific Findings Phenolic compounds have exerted antioxidant, anti-inflammatory, and antimicrobial effects in laboratory studies.63–65 Thyme exerted DNAprotective activity in a laboratory study.66

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Tofu Definition White gelatin-like curd formed when soybean protein is precipitated. Its firmness is determined by the amount of liquid it contains, e.g., silken tofu contains a high amount of liquid, whereas firm tofu contains less liquid. Tofu is a rich source of soy protein and can be a good source of calcium, depending on whether the soybean is precipitated with a calcium compound, such as calcium chloride, but tofu is not a source of vitamin B12, unless it has been fortified with vitamin B12 which would be stated in the ingredients list. Tofu is used in Asian-inspired cuisine such as miso soup and as a meat substitute in stir-fries. Soybean-based foods have been common in Asian diets for thousands of years.67

Scientific Findings Daily soy protein intake has a mild LDL-lowering effect,67 especially when substituted for animal protein.68

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Tomatillo (Physalis philadelphica)

333

Tomatillo (Physalis philadelphica)

Definition Miniature green tomato-like vegetable used to make salsa verde (green salsa). A medium, 34-g tomatillo contains 10 calories, 1 g of fiber (3% DV) and 4 mg vitamin C (4% DV) and is a source of phytochemicals including lutein, beta-carotene, and ixocarpalactone A.71,72

Scientific Findings Ixocarpalactone A has been shown to be a cancer chemopreventive agent against human cancer cell lines in laboratory studies.44,73

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

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334

Turmeric (Curcuma longa)

Tomato (Lycopersicon esculentum) Definition Popular culinary vegetable that is botanically classified as a fruit. A source of many phytochemicals including lycopene, a carotenoid, which is concentrated in processed tomato products, e.g., the lycopene content in one cup of tomato juice (salt added) is 21,960 µg (21.9 mg) whereas there are 3,834 µg (3.8 mg) in 1 cup of fresh cherry tomatoes.69

Scientific Findings Tomato consumption, specifically, tomato foods, cooked tomatoes, and sauces, but not raw tomatoes, were associated with a reduced risk of prostate cancer risk in a systematic review and meta-analysis of 30 studies that summarized data from 24,222 cases and 260,461 participants.70

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Turmeric (Curcuma longa) Definition Herb member of the ginger family that is known for its golden color used to make curry powder, yellow mustard, and Indian cuisine. The whole rhizome (underground stem) is peeled and used to make healthy smoothies. Its flavor has been described as mildly aromatic with the essence of orange or ginger and a pungent, bitter flavor.74 Traditional uses of turmeric include to aid in digestion and liver function, relieve arthritis pain, and regulate menstruation.75

Scientific Findings Curcumin, a vanilloid compound in turmeric, exhibited apoptotic, antiinflammatory, chemoprotective, antitumor, antioxidant, antiarthritic, anti-amyloid, anti-ischemic, anti-inflammatory, hepatoprotective, and bone-protective effects.76–81

References

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Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals. High doses of turmeric may cause indigestion, nausea, or diarrhea.82

Turnip (Brassica rapa) Definition White or white-and-purple Brassica root vegetable that varies in size and has been used as a vegetable for human consumption in Europe since prehistoric times.83 One cup of raw turnip is low in calories (36 calories) and carbohydrate (8 g, 2% DV), and high in vitamin C (38 mg, 42% DV).84 Its greens, commonly boiled or cooked with ingredients such as meats, onions, and garlic, are rich in phenolics and glucosinolates.85

Scientific Findings See: Brassica Vegetables.

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals. Goitrin in turnip blocks uptake of iodine into the thyroid gland, but cooking destroys goitrin, thus negating its anti-thyroidal potency.86



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rm=&n​dbno=​& nutr​ient1​=&nut​r ient​2=&nu​t rien​t 3=&s​u bset​=&tot​Count​ =&mea ​ s ureb​ y=&Qv​ =1&Q3 ​ 3 0136 ​ = 8&Q3 ​ 3 0137​= 6.0& ​ Q 3301​ 3 8=1& ​ Q v=1&​ Q3301​36=1&​Q3301​37=6.​0&Q33​0138=​1. 33. Goldbohm RA, Hertog MG, Brants HA, van Poppel G, van den Brandt PA. Consumption of black tea and cancer risk: a prospective cohort study. J Natl Cancer Inst. 1996 Jan 17;88(2):93–100. 34. Boehm K, Borrelli F, Ernst E, Habacher G, Hung SK, Milazzo S, Horneber M. Green tea (Camellia sinensis) for the prevention of cancer. Cochrane Database Syst Rev. 2009 Jul 8;(3):CD005004. 35. US Department of Health and Human Services. National Institutes of Health. National Cancer Institute. Tea and cancer prevention. www.c​a ncer​ .gov/​about​- canc​er/ca​u ses-​preve​ntion​/risk​/diet​/tea-​fact-​sheet​. Accessed August 2, 2018. 36. Wagner K-H, Elmadfa I. Biological relevance of terpenoids. Ann Nutr Metab. 2003;47(3–4):95–106. 37. Mayuoni-Kirshinbaum L. The flavor of pomegranate fruit: a review. Porat RJ Sci Food Agric. 2013 Jul 23;94(1):21–27. 38. Breitmaier E, ed. Terpenes: Importance, General Structure, and Biosynthesis. Germany: Wiley VCH Verlag; 2006. 39. Kushi LH, Doyle C, McCullough M, Rock CL, Demark-Wahnefried W, Bandera EV, Gapstur S, Patel AV, Andrews K, Gansler T; The American Cancer Society 2010 Nutrition and Physical Activity Guidelines Advisory Committee. American Cancer Society guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J Clin. 2012;62(1):30–67. 40. Institute of Medicine. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. Washington, DC: National Academy Press; 1998. 41. Smolin LA, Grosvenor MB. Nutrition Science and Applications. 2nd edn. Fort Worth, TX: Harcourt Brace College Publishers; 1997. 42. Balk E, Chung M, Raman G, Tatsioni A, Chew P, Ip S, DeVine D, Lau J. B Vitamins and berries and age-related neurodegenerative disorders. Evidence Report/Technology Assessment No. 134. (Prepared by Tufts-New England Medical Center Evidence-based Practice Center under Contract No. 290-02-0022). AHRQ Publication No. 06-E008. Rockville, MD: Agency for Healthcare Research and Quality. April 2006. 43. Dinicolantonio JJ, Lavie CJ, Niazi AK, O'Keefe JH, Hu T. Effects of thiamine on cardiac function in patients with systolic heart failure: systematic review and metaanalysis of randomized, double-blind, placebo-controlled trials. Ochsner J. 2013;13(4):495–499. 44. Ijaz S, Thorley H, Porter K, Fleming C, Jones T, Kesten J, Mamluk L, Richards A, Marques EMR, Savović J. Interventions for preventing or treating malnutrition in homeless problem-drinkers: a systematic review. Int J Equity Health. 2018;17(1):8. 45. Rao SN, Chandak GR. Cardiac beriberi: often a missed diagnosis. J Trop Pediatr. 2010;56(4):284–285. 46. Grosvenor MB, Smolin LA. Visualizing Nutrition Everyday Choices. Hoboken, NJ: John Wiley & Sons; 2010.

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47. Imai N, Kubota M, Saitou M, Yagi N, Serizawa M, Kobari M. Increase of serum vascular endothelial growth factors in wet beriberi: two case reports. Intern Med. 2012;51(8):929–932. 48. Becker DA, Ingala EE, Martinez-Lage M, Price RS, Galetta SL. Dry Beriberi and Wernicke's encephalopathy following gastric lap band surgery. J Clin Neurosci. 2012;19(7):1050–1052. 49. Osiezagha K, Ali S, Freeman C, Barker NC, Jabeen S, Maitra S, Olagbemiro Y, Richie W, Bailey RK. Thiamine deficiency and delirium. Innov Clin Neurosci. 2013;10(4):26–32. 50. Donnino MW, Vega, J, Miller H, Walsh M. Myths and misconceptions of Wernicke’s encephalopathy: what every emergency physician should know. Ann Emerg Med. 2007;50(6):715–721. 51. National Institutes of Health. US National Library of Medicine. WernickeKorsakoff syndrome. https​://me​dline​plus.​gov/e​ncy/a​rticl​e/000​771.h​tm. Accessed August 5, 2018. 52. Sechi GP, Serra A. Wernicke's encephalopathy: new clinical settings and recent advances in diagnosis and management. Lancet Neurol. 2007;6(5):442–455. 53. National Institutes of Health. US National Library of Medicine. WernickeKorsakoff syndrome. https​://me​dline​plus.​gov/e​ncy/a​rticl​e/000​771.h​tm. Accessed August 5, 2018. 54. Tang L, Alsulaim HA, Canner JK, Prokopowicz GP, Steele KE. Prevalence and predictors of postoperative thiamine deficiency after vertical sleeve gastrectomy. Surg Obes Relat Dis. 2018; 14(7): 943–950. 55. Nestor PJ. Korsakoff psychosis. In: Neurology and Clinical Neuroscience, Schapira AHV, Wszolek ZK, eds. Philadelphia, PA: Mosby Elsevier; 2017. 56. Brady JA, Rock CL, Rhornefer M. Thiamin status, diuretic medications, and the management of congestive heart failure. J Am Diet Assoc. 1995;95(5):541–544. 57. Baines M, Bligh JG, Madden JS. Tissue thiamin levels of hospitalised alcoholics before and after oral or parenteral vitamins. Alcohol. 1988;23(1):49–51. 58. Jacques PF, Taylor A, Moeller S, Hankinson SE, Rogers G, Tung W, Ludovico J, Willett WC, Chylack LT Jr. Long-term nutrient intake and 5-year change in nuclear lens opacities. Arch Ophthalmol. 2005;123(4):517–526. 59. Cumming RG, Mitchell P, Smith W. Diet and cataract: the Blue Mountains Eye Study. Ophthalmology. 2000 Mar;107(3):450–456. 60. Schabelman E, Kuo D. Glucose before thiamine for Wernicke encephalopathy: a literature review. J Emerg Med. 2012;42(4):488–494. 61. USDA Agricultural Research Service. Medicinal plants and herbs. Thyme. www.p​l.bar​c.usd​a.gov​/usda​_plan​t/pla​nt_ho​me.cf​m. Accessed June 19, 2011. 62. Dornenberg A, Page K. Culinary Artistry. New York: Van Nostrand Reinhold; 1996. 63. Martínez-Valverde I, Periago MJ, Ros G. Nutritional importance of phenolic compounds in the diet. Arch Latinoam Nutr. 2000;50(1):5–18. 64. Abidi W, Jiménez S, Moreno MÁ, Gogorcena Y. Evaluation of antioxidant compounds and total sugar content in a nectarine [Prunus persica (L.) Batsch] Progeny. Int J Mol Sci. 2011;12(10):6919–6935. 65. Crozier A, Jaganath IB, Clifford MN. Dietary phenolics: chemistry, bioavailability and effects on health. Nat Prod Rep. 2009;26(8):1001–1043.

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66. Kozics K, Klusová V, Srančíková A, Mučaji P, Slameňová D, Hunáková L, Kusznierewicz B, Horváthová E. Effects of Salvia officinalis and Thymus vulgaris on oxidant-induced DNA damage and antioxidant status in HepG2 cells. Food Chem. 2013;141(3):2198–2206. 67. National Institutes of Health National Center for Complementary and Alternative Medicine. Herbs at a glance. Soy. http:​//ncc​am.ni​h.gov​/heal​th/ so​y/ata​glanc​e.htm​. Accessed August 5, 2018. 68. Academy of Nutrition and Dietetics Evidence Analysis Library. Critical illness nutrition practice guideline. www.a​daevi​dence​libra​ry.co​m/top​ic.cf​m ?cat​=2799​&libr​ary=E​BG. Accessed March 10, 2011. 69. US Department of Agriculture. Agricultural Research Service. Nutrient Data Laboratory. USDA National Nutrient Database for Standard Reference, Legacy. Version Current: April 2018. https​://nd​b.nal​.usda​.gov/​ndb/n​utrie​ nts/r​eport​?nutr​ient1​=337&​nutri​ent2=​& nutr​ient3​=&&ma​x=25&​subse​t=0& o​ffset​=75&s​ort=c​&totC​ount=​5220&​measu​reby=​m. Accessed August 5, 2018. 70. Rowles JL 3rd, Ranard KM, Applegate CC, Jeon S, An R, Erdman JW Jr. Processed and raw tomato consumption and risk of prostate cancer: a systematic review and dose-response meta-analysis. Prostate Cancer Prostatic Dis. 2018;21:319–336. 71. Elizalde-González MP, Hernández-Ogarcía SG. Effect of cooking processes on the contents of two bioactive carotenoids in Solanum lycopersicum tomatoes and Physalis ixocarpa and Physalis philadelphica tomatillos. Molecules. 2007 Aug 13;12(8):1829–1835. 72. US Department of Agriculture. SNAP-Ed Connection. Tomatillos. http:​// sna​p.nal​.usda​.gov/​nutri​tion-​throu​gh-se​asons​/seas​onal-​produ​ce/to​matil​los. Accessed March 24, 2015. 73. Maldonado E, Pérez-Castorena AL, Garcés C, Martínez M. Philadel­ phicalactones C and D and other cytotoxic compounds from Physalis philadelphica. Steroids. 2011 Jun;76(7):724–728. 74. Spice Encyclopedia. Turmeric. www.s​picea​dvice​.com/​encyc​loped​ia/Tu​ rmeri​c.htm​l. Accessed August 5, 2018. 75. National Institutes of Health. National Center for Complementary and Integrative Health. Turmeric. https​://nc​cih.n​ih.go​v/hea​lth/t​urmer​ic/at​ aglan​ce.ht​m. Accessed August 5, 2018. 76. Shukla PK, Khanna VK, Ali MM, Khan MY, Srimal RC. Anti-ischemic effect of curcumin in rat brain. Neurochem Res. 2008;33(6):1036–1043. 77. Stix G. Scientific American. Spice healer.. www.s​cient​ifica​meric​an.co​m/art​ icle.​cfm?i​d=spi​ce-he​aler. Accessed August 3, 2013. 78. Aggarwal BB, Shishodia S. Molecular targets of dietary agents for prevention and therapy of cancer. Biochem Pharmacol. 2006;71(10):1397–1421. 79. Itoh A, Isoda K, Kondoh M, Kawase M, Kobayashi M, Tamesada M, Yagi K. Hepatoprotective effect of syringic acid and vanillic acid on concanavalin A-induced liver injury. Biol Pharm Bull. 2009;32(7):1215–1219. 80. Choi H, Chun YS, Kim SW, Kim MS, Park JW. Curcumin inhibits hypoxiainducible factor-1 by degrading aryl hydrocarbon receptor nuclear translocator: a mechanism of tumor growth inhibition. Mol Pharmacol. (American Society for Pharmacology and Experimental Therapeutics). 2006;70(5):1664–1671. 81. Wright LE, Frye JB, Timmermann BN. Protection of trabecular bone in ovariectomized rats by turmeric Curcuma longa L. is dependent on extract composition. J Agric Food Chem. 2010;58(17):9498–9504.

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82. National Institutes of Health. National Center for Complementary and Integrative Health. Turmeric. https​://nc​cih.n​ih.go​v/hea​lth/t​urmer​ic/at​ aglan​ce.ht​m. Accessed April 8, 2015. 83. Undersander DJ, Kaminski AR, Oakley EA, Smith LH, Doll JD, Schulte EE, Plunger ES. Turnip. Alternative field crops manual. University of WisconsinExtension, Cooperative Extension, University of Minnesota. www.h​ ort. p​urdue​.edu/​newcr​op/af​cm/tu​rnip.​html. Accessed March 24, 2015. 84. US Department of Agriculture. Agricultural Research Service. Nutrient Data Lab. Turnip raw. http:​//ndb​.nal.​usda.​gov/n​db/fo​ods/s​how/3​274? f​gcd=&​manu=​&lfac​et=&f​ormat​=&cou​nt=&m​ax=35​&offs​et=&s​ort=&​qlook​ up=tu​rnip. Accessed March 25, 2015. 85. Francisco M, Crate ME, Songs P, Velasco P. Effect of genotype and environmental conditions on health-promoting compounds in Brassica rape. J Agric Food Chem. 2011;59(6):2421–2431. 86. Baja JK, Salwan P, Salwan S. Various possible toxicants involved in thyroid dysfunction: a review. J Clin Diagnostic Res. 2016;10(1):FE01–FE03.

T

U Ugli fruit (Citrus paradisi x reticulata)

Definition Also known as unique fruit and ugli tangelo. Ugli fruit is a hybrid of a mandarin and a grapefruit1 that is native to Jamaica.2 Larger than an orange with yellow-green, easily peeled skin, ugli fruit eaten fresh is an excellent source of vitamin C and fiber.2

U

Scientific Findings See: Citrus.

Bioactive Dose Not known.

343

U

344

References

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

References 1. Purdue University. Tangelo Citrus paradisi × Citrus reticulate. www.h​ort. p​urdue​.edu/​newcr​op/mo​rton/​tange​lo.ht​ml. Accessed April 14, 2015. 2. Produce for Better Health. Ugli fruit. www.f​ruits​andve​ggies​morem​atter​s. org​/ugli​-frui​t-nut​ritio​n-sel​ectio​n-sto​rage. Accessed April 2, 2015.

V Vegetables Definition Under-consumed food group1 that has been divided into five subgroups by color: dark green (e.g., broccoli), starchy (e.g., potatoes), beans and peas (e.g., lentils), red and orange (e.g., tomatoes and carrots), and “other,” or those not otherwise categorized (e.g., artichokes, mushrooms, wax beans, zucchini, etc.), each having different nutrient and phytochemical constituents. As a group, vegetables supply folate, beta-carotene, vitamins C, K, and E, magnesium, potassium, and fiber.2 Different colored vegetables are characteristically rich in certain nutrients, e.g., dark green vegetables are particularly rich in folate, vitamin K, and magnesium, therefore ChooseMyPlate.gov advice to “Vary your veggies” promotes consuming an array of nutrients and phytochemicals. Each vegetable may contain more than 100 different phytochemicals.3,4 Biologic mechanisms whereby vegetables exert healthful effects are likely to be multiple and include both nutrients and phytochemicals.5 Fruits and vegetables, low in calories because they’re high in fiber and water, promote fullness and volume. Vegetables are good substitutes for foods of high energy density. 6

Scientific Findings Low vegetable consumption is a factor, along with reduced fruit consumption, linked to poor health and increased risk of noncommunicable diseases.7 A diet rich in vegetables, as part of an overall healthy diet, may reduce the risk of heart disease, including heart attack and stroke; certain types of cancer; obesity; Type II diabetes; blood pressure; kidney stones; and bone loss.8 People whose diets are rich in vegetables (and fruits) have a lower risk of developing cancers of the mouth, pharynx, larynx, esophagus, stomach, and lung; and some evidence suggests this dietary pattern also lowers the risk of cancers of the colon, pancreas, and prostate, in addition to lowering the risk of developing diabetes, heart disease, hypertension, and overweight.9 Consuming a diet containing high amounts of vegetables (and fruits) is associated with fewer age-related diseases, such as Alzheimer’s Disease.10

345

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Vinegar

Bioactive Dose The daily vegetable recommendation for general health for women (age 19–50) is 2.5 cups, and for men (age 19–50) is 3 cups.8 Cancer-preventative recommendations for men and women are to consume 1.14 daily cup equivalents of vegetables per 1,000 calories, with at least 0.55 cup equivalents of dark green or orange vegetables or legumes per 1,000 calories. Since 2,000 calories is a typical reference amount, the approximate daily recommendation is 2 ¼–2 ½ cups with 1 cup from legumes or dark green or orange vegetables.13

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Vinegar Definition Acidic edible liquid made from fermented carbohydrate that is used to impart sour flavoring, make condiments such as salad dressing, mustard, and ketchup, and to ferment foods, such as pickles and sauerkraut. One of its many phytochemical components is cinnamate, a polyphenolic compound (also found in beer, carrots, cereal brans, garlic, mung bean, peanuts, strawberry, raspberry, spinach, and wine).11–13 Vinegar has a long history of use dating to Babylonia in 5000 BC14

Scientific Findings In laboratory animals, coumaric acid reduced LDL cholesterol levels15 and exhibited significant neuroprotective activity following an ischemiareperfusion injury of the spinal cord.16 In a 12-week, double-blind, placebo-controlled RCT trial (n = 176 obese subjects), 15 ml of vinegar reduced body weight, body fat mass, and serum triglyceride levels in the treatment group.14

Bioactive Dose Not known.

Safety Presumed safe when consumed in normal dietary quantities by nonallergic individuals.

Vitamin A

347

Vitamin A Definition Fat-soluble vitamin necessary for vision and corneal health, growth, epithelial cell integrity, reproduction, gene expression, immune function, embryonic development, cell differentiation, to increase collagen production and improve wound healing, in addition to other functions.17–20 Food groups that supply vitamin A are vitamin-A-fortified dairy foods, fruits, and vegetables. Preformed, active vitamin A (retinol is one of several types), is found in animal foods, including fortified milk, cereal, and margarine; fatty fish; eggs; and liver. Provitamin A carotenoids, such as beta-carotene, alphacarotene, and beta-cryptoxanthin, are concentrated in dark green, orange, and yellow fruits and vegetables, such as spinach, apricots, squash, and carrots.17 Provitamin A carotenoids serve as antioxidants or can be converted into vitamin A. Xerophthalmia, referring to the ocular abnormalities resulting from A deficiency, has been known for 3,500 years and was treated in ancient Assyria, Egypt, and Greece with foods now known to be rich in preformed vitamin A.21 The median intake of vitamin A in the US is lower than the RDA for vitamin A for individual men and women, but are considered to be adequate for population groups.17 Vitamin A deficiency is characterized by eye and visual changes, such as drying and hardening of the cornea and night blindness, progressing to blindness; skin keratinization; susceptibility of the salivary glands and other mucous membranes to infection; general body-wide susceptibility to infection; impaired digestion and absorption; growth retardation; increased risk of death due to infectious disease; and death.21–23 Vitamin A deficiency can occur due to abnormal storage and transport of vitamin A in people with abetalipoproteinemia, protein or zinc deficiency, diabetes mellitus, hyperthyroidism, fever, liver disease, cystic fibrosis, malabsorption, and due to other conditions that limit intake, absorption, or utilization of vitamin A.20,24 Risk Groups for Deficiency and Excess Risk of Vitamin A Deficiency

• Preterm infants, who have low stores as a result of interrupted accretion during gestation • Infants and children, particularly those whose mothers are vitamin A deficient during lactation • People with malabsorption conditions including biliary atresia and cystic fibrosis • People living in food-insecure environments without access to fortified foods • Individuals suffering from alcoholism Risk of vitamin A Excess

• People with access to multiple fortified foods or who consume liver on a regular basis • Chronic preformed vitamin A supplement users Source: 21

The most commonly used biomarker to assess vitamin A status is plasma retinol concentration; but because plasma levels do not decline

V

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348

Vitamin A

until vitamin A levels in the liver are almost depleted, plasma retinol cannot detect marginal vitamin A status. Plasma retinol is also affected by recent dietary intake and is suppressed by infection and inflammation.17,21,24,25 Liver vitamin A concentration is considered the gold standard for measuring vitamin A status,21 while retinol isotope dilution, is less invasive and an indirect method to evaluate liver vitamin A concentration.25,26 Excessive preformed vitamin A (but not beta-carotene) intake can lead to hypercalcemia and may negatively impact bone mineral density (BMD).17,27

Scientific Findings Vitamin A deficiency contributes to iron deficiency anemia.23 Sweet potatoes are used to prevent vitamin A deficiency disease and blindness in regions of endemic vitamin A deficiency.19,28 Adequate serum concentrations of retinol and beta-carotene minimized the side effects of radiation in breast cancer patients in an observational study (n = 230 patients mean age 63.6 years).20,29 Concentrations of uric acid were significantly and positively associated with concentrations of vitamin A (an undesirable effect), and inversely (a desirable effect) with concentrations of beta-carotene in a nationally representative sample of US adults (n = 10,893 participants aged ≥ 20 years) in The National Health and Nutrition Examination Survey.30

Bioactive Dose The RDA for adult men aged 19–50 is 900 µg/day Retinol Activity Equivalents (RAE)31 (3000 IU)32 and for adult, non-pregnant women aged 19–50: 700 µg/day RAE33 (2333 IU).34

Safety The vitamin A UL is 3,000 μg (10,000 IU).35,36 Exceeding the UL during pregnancy, with preformed vitamin A sources (natural preformed vitamin A foods, A-fortified cereals, and dietary supplements), is associated with teratogenicity including orofacial malformation.37 Tissue levels take a long time to fall after high doses, and the resulting liver damage may or may not be reversible after discontinuing vitamin A.17,24 Either short-term, massive intakes or chronic high intakes of vitamin A can cause hypervitaminosis A characterized by increased intracranial/cerebral spinal fluid pressure; headache; dizziness; nausea; bone demineralization; alopecia; skin irritation/skin rashes and desquamation; pain in joints and bones; liver damage/hepatomegaly, anemia, coma, and death.21,24

Vitamin B6

349

Vitamin B1 see: Thiamin Vitamin B2 see: Riboflavin Vitamin B3 see: Niacin

Vitamin B6 Definition Related forms: pyridoxine, pyridoxal, pyridoxamine, and each form paired with phosphate, e.g., pyridoxal phosphate.38 Water-soluble vitamin required for protein, carbohydrate, and lipid metabolism; tryptophan conversion to niacin; erythrocyte metabolism and function; nervous system function and neurotransmitter synthesis; homocysteine degradation; immune function; cognitive function; and other roles.39–41 Vitamin B6 (B6) sources include fortified, ready-to-eat cereals; all members of the protein foods group (meat, poultry, seafood, egg, legumes or tofu, nuts, seeds, and soy products); white potatoes and starchy vegetables; and non-citrus fruits, including bananas and watermelon.2,42 Median B6 dietary intake in the US has been estimated to be higher than the B6 RDA.43 Deficiency of B6 (and other B vitamins including folate and B12), caused by inadequate intake, decreased absorption, or increased requirement, is associated with hyperhomocysteinemia (see also: Folate). B6 status is measured by using plasma pyridoxal phosphate; values of > 20–30 nmol/L have been suggested as the lower end of normal status.44,45 Symptoms of deficiency include depression, confusion, stomatitis, cheilosis, glossitis, irritability, seborrheic dermatitis, convulsions, poor growth, decreased immune function, hypochromic microcytic anemia, convulsions, and electroencephalogram abnormalities.40,46

Scientific Findings “Elevated homocysteine level is an independent predictor for all-cause mortality and it compromises [the] health of all organ systems.”47 In the Taiwan Elderly Nutrition and Health Survey (n = 1094 males and 1135 females aged 65–90 years), B6 status was significantly lower in males with hyperhomocysteinemia, though the same was not true for females.45 B6 can raise serotonin levels in serotonin deficiency.48 Low B6 status was associated with increased pro-inflammatory markers.49 A meta-analysis of 32 published trials (n = 8,401 cases and 11,009 controls) found that decreased blood B6 levels increased the risk of colorectal cancer.47 In three cases of seizures refractory to conventional antiepileptic medications, seizures persisted despite escalation of conventional antiepileptic medications but resolved within 2 days of pyridoxine supplementation and corrected low serum pyridoxal 5'-phosphate concentrations; researchers concluded that

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Vitamin B12

refractory seizures caused by vitamin B6 deficiency, although rare, should be considered in critically ill adult patients with refractory seizures.50

Bioactive Dose The RDA is 1.3 mg/day for men and non-pregnant women aged 19–50.

Safety The Tolerable Upper Intake Level (UL) for adults is 100 mg of B6. Usually, dietary supplement use is associated with toxicity; no adverse effects have been associated with high intakes of food B6.51 Doses exceeding the UL might result in peripheral neuropathy.52

Vitamin B12 Definition Also called cobalamin and cyanocobalamin. Water-soluble vitamin necessary for folate metabolism, DNA synthesis, red blood cell formation, to convert homocysteine to methionine, to synthesize the myelin sheath of nerves, for fatty acid metabolism, and other numerous additional functions.53,54 Vitamin B12 (B12) is found in all animal foods, including meat, poultry, fish and shellfish, eggs, and dairy products, but is not found naturally in plant foods. Nori (seaweed) contains nominal amounts of natural B12. Generally, “nothing that grows out of the ground contains [B12].”55 Soymilk, certain ready-to-eat cereals, and vegetarian meat substitutes may be fortified with crystalline B12, which is also used in dietary supplements. Crystalline B12 is more bioavailable than natural food B12.56 The amount of B12 in the average Western diet (5–15 µg/d) is more than sufficient to meet the RDA of 2 µg/d.57 Separation of B12 from food protein and from secreted proteins involve pepsin, gastric acid, and pancreatic proteases. Free, unbound B12 attaches to intrinsic factor forming an intrinsic factorB12 complex that is absorbed in the small intestine. A small amount of B12 not bound to IF is absorbed by passive diffusion.55 The liver stores 3–5 mg, of which 50% is in the liver.40 It can take years to use body stores and B12 deficiency can take months to years to become symptomatic;20,55 however, B12 stores become significantly depleted by a persistent vegetarian diet.58 B12 deficiency may readily develop in elderly vegetarians.58 Cobalamin deficiency is common worldwide.59 No single parameter can be used to diagnose cobalamin deficiency.59 Diagnosis of B12 deficiency requires a complete blood count and measurement of serum B12, but measurement of serum homocysteine and methylmalonic acid (MMA) should be used

Vitamin B12

351

to confirm deficiency in asymptomatic high-risk patients with low-normal levels of B12.56 Serum B12 is neither sensitive nor is it specific for B12 deficiency.59 For example, a study of patients with myeloproliferative disorders (n = 58) found a high prevalence of B12 deficiency, despite high serum vitamin B12 levels.60 “Numerous studies have now established that serum B12 has limited diagnostic value as a stand-alone marker.”61 Serum homocysteine and MMA are metabolites that arise from B12 insufficiency, and they are more sensitive indicators of B12 deficiency than the serum B12 value.62 High homocysteine and high MMA are associated with low levels of serum B12. Serum holotranscobalamin (the metabolically active vitamin B12 fraction) has been proposed as a better marker for assessing initial B12 status, to replace serum B12, and to accompany serum MMA and serum homocysteine levels.59 Serum holotranscobalamin is an earlier marker that decreases before total serum B12 declines.59 B12 deficiency is characterized by megaloblastic anemia; low or low-normal serum B12 (normal = 170–250 pg/mL63), elevated homocysteine, elevated MMA, and low serum holotranscobalamin. Symptoms of B12 deficiency include neurological complications such as sensory disturbances especially in the lower extremities including paresthesias such as tingling and numbness, loss of sensation, loss of strength in limbs, ataxia, slowed or increased reflexes, and vibration and position sensitivity; as well as neuropsychiatric symptoms, such as irritability, memory loss, and dementia.56,64–66 Neurological signs of B12 deficiency can occur in patients with normal hematocrit and red cell indices.64 Patients with B12 deficiency may not exhibit all symptoms because B12 deficiency symptoms span a continuum.56 The elderly are considered to be at high risk for B12 deficiency because they have a higher incidence of gastric mucosa atrophy, altered production of intrinsic factor, and altered gastric acid secretion;54 B12 malabsorption is common in elderly subjects.59 Approximately 10–30% of people over age 50 do not absorb food-bound B12 efficiently.67 Low serum B12 concentrations are found in more than 10% of older adults.68 The average age of onset of B12 deficiency in the elderly has been estimated to be between 60 and 70 years.64 Other groups at risk for B12 deficiency include: vegans and people with low intake of animal foods; those who: lack intrinsic factor (including those with autoimmune atrophic gastritis, pernicious anemia, and gastrectomy); have bacterial overgrowth of the small intestine; are infected with the B-12-consuming parasite Diphyllobothrium latum; have disease of or who have had resection of the terminal ileum; have pancreatic disease or insufficiency; in addition to: patients with Crohn’s Disease, celiac disease, thyrotoxicosis, hemolytic anemia, hemorrhage, malignancy, hepatic disease, renal disease, myeloproliferative disorders, and/or who use drugs that suppress gastric acid production or otherwise interfere with B12 absorption or metabolism, such as cholestyramine or metformin, among other medications.20,56,60,64,69–71

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Vitamin C

Scientific Findings B12 deficiency may go undetected in vegetarians because their diets are rich in folate, which can mask the diagnosis of B12 deficiency (the hematological effects of B12 deficiency are indistinguishable from those of folate deficiency).58 For individuals who are at risk of B12 deficiency, B12fortified food and/or dietary supplements should be used, rather than relying solely on food sources of B12.56 Plasma homocysteine rises in deficiency of B12 (as well as in deficiency of folate and B6—see also Folate and Vitamin B6).40 B12 supplementation has not been shown to improve cardiovascular outcomes, cognitive decline, or hyperhomocysteinemia in people with low serum B12 levels and dementia.56,72 High serum homocysteine is a risk factor for fractures, the pathophysiology of which is unclear but may involve bone mineral density (BMD), bone turnover, bone blood flow, DNA methylation, and/or physical function and fall risk.73

Bioactive Dose The RDA is 2.4 µg/day for men and non-pregnant women aged 19–50. According to one nutrition authority, “further research may be required to determine appropriate levels of oral B12 supplementation for deficient older adults,”74 however, others have found that an oral dose of 1–2 mg daily has been used to correct deficiency and “is as effective as intramuscular administration for correcting deficiency, regardless of etiology.”56 Intramuscular injection may be more appropriate in severe cases of deficiency with neurological involvement or in patients with diarrhea or vomiting or nonadherence to taking medications orally.20

Safety No UL has been established for B12. “No adverse effects have been associated with excess B12 intake from food or supplements in healthy individuals.”75

Vitamin C Definition Also called ascorbic acid and ascorbate. Water-soluble antioxidant vitamin that reduces cellular oxidative stress, scavenges free radicals, and inhibits peroxidation of membrane phospholipids. It is necessary for various components of immune response, collagen metabolism, and synthesis of amino acids, collagen, carnitine, cholesterol, hormones, and neurotransmitters76–78 Vitamin C (C) increases the intestinal absorption

Vitamin C

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of nonheme iron79 either by changing iron’s ionic state in its capacity as an electron donor,77 or by forming a soluble complex with iron in the alkaline pH of the small intestine.80 The C deficiency disease scurvy caused illness and death through the end of the 18th century when its cause and treatment were established.81 Scurvy afflicts those with low socioeconomic status, alcoholism, severe psychiatric illness leading to poor nutrition, and critical illness.81 Impaired wound healing, petechiae, bleeding gums, and loose teeth occur due to the inability of the body to make collagen; other manifestations of scurvy include synovitis with effusion, anemia, markedly elevated erythrocyte sedimentation rate and C-reactive protein levels, pulmonary hypertension, purpuric rash, and hemarthrosis.82 The fruit and vegetable groups supply C. Approximately 30% of Americans failed to consume adequate C from foods in a nationally representative survey comparing intake to Estimated Average Requirement.83

Scientific Findings Plasma ascorbic acid concentration was inversely related to mortality from all causes in men and women, including cardiovascular disease and ischemic heart disease, and to cancer mortality in men, but not women, in a prospective observational study (n = 19,496 subjects aged 45–79 years). The study concluded that eating the equivalent of 50 g (one typical serving) of fruit or vegetables daily increased plasma ascorbate levels to cancer-protective levels.20,84 Intake of dietary C and several food groups high in C content were inversely related to hypertension, whereas supplemental C was not in the CARDIA prospective cohort study (n = 2,884 black and white adults) in which dietary quality, plasma ascorbate levels, and cases of hypertension were measured over a 25-year period.85 A 14.2-year observational study that evaluated all-cause, cancer and cardiovascular mortality risks and serum antioxidant levels (n = 16,008 adult in the Third National Health and Nutrition Examination survey, 1988–1994) found that a dose-response decrease in cancer and overall mortality risk was associated with higher C levels.86

Bioactive Dose The RDA is 75 mg for nonsmoking women and 90 mg for nonsmoking men age 19–50. The requirement for smokers is increased by 35 mg/day.

Safety The UL is 2,000 mg for adults aged 19–50. With large doses, unabsorbed ascorbate is degraded in the intestine, a process that may account for

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Vitamin D

diarrhea and intestinal discomfort.87 In doses of 500 mg or more, such as in dietary supplements, C has exhibited pro-oxidant properties in vitro.88

Vitamin D Definition Vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol) are the two major, naturally occurring types of vitamin D (D), a fat-soluble vitamin and hormone. D2 is found in mushrooms and is used to make dietary supplements.89,90 D3 is found in egg yolks; heavy cream; American cheese; meats including beef, turkey, and pork; fatty fish; and D-fortified milk-soymilkrice milk-almond milk-coconut milk/margarine/orange juice/ready-to-eat breakfast cereals/and nutrition drinks and bars; it is also used in dietary supplements. Dairy products other than milk generally are not fortified with D: it should not be assumed that yogurt, cheese, ice cream, and other dairy foods are sources of D unless the ingredient list lists specifically includes “vitamin D.” D is classified as a nonessential nutrient because it can be synthesized by the exposure of skin to the sun. Precursor D3 in the skin is converted into D3 by skin exposure to UVB radiation. Both D2 and D3 require hydroxylation by the kidney and liver to be converted into 1,25-dihydroxyvitamin D, also called calcitriol, the active D metabolite that performs skeletal and nonskeletal roles.90,91 Total serum 25-hydroxyvitamin D, the major circulating form of D derived from dietary intake and sunlight exposure, is used to measure D adequacy. Though there is lack of agreement on “optimal” total serum 25-hydroxyvitamin D level, 25–80 ng/mL is a target range in use in clinical practice.90 Hypovitaminosis D has been described as total serum 25-hydroxyvitamin D